{
  "hospital_name": "Resnick Neuropsychiatric Hospital at UCLA",
  "last_updated_on": "2026-03-29",
  "as_of_date": "2026-01-01",
  "version": "3.0.0",
  "location_name": [
    "Resnick Neuropsychiatric Hospital at UCLA"
  ],
  "hospital_address": [
    "150 UCLA Medical Plaza, Los Angeles, CA 90095"
  ],
  "license_information": {
    "license_number": "930000153|CA",
    "state": "CA"
  },
  "type_2_npi": [
    "1952308363"
  ],
  "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": "0.9% SODIUM CHLORIDE--CONTROL FOR ATG",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "63323018610",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "1ST OPN IMPLT BAT MODULJ SYS",
  "code_information": [
    {
      "code": "64654",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 24570.27,
      "maximum": 45000.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24570.273,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24570.273,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45000.5,
          "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": 45000.5,
          "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": 56.67,
      "maximum": 103.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.18175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103.79,
          "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": 103.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "2019-ncov diagnostic p",
  "code_information": [
    {
      "code": "U0001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.61,
      "maximum": 35.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.476632,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "2d cephal radio image",
  "code_information": [
    {
      "code": "D0702",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 48.54,
      "maximum": 88.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.54486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.54486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.901655,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 88.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 88.91,
          "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": 48.54,
      "maximum": 88.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.54486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.54486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.901655,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 88.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 88.91,
          "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": 48.54,
      "maximum": 88.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.54486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.54486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.901655,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 88.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 88.91,
          "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": 437.29,
      "maximum": 800.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 437.2914,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 437.2914,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 582.353226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 800.9,
          "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": 800.9,
          "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": 437.29,
      "maximum": 800.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 437.2914,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 437.2914,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 582.353226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 800.9,
          "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": 800.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "2d tte w or w/o fol w/con,fu",
  "code_information": [
    {
      "code": "C8924",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 194.61,
      "maximum": 356.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 194.61078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 194.61078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 263.240523,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 356.43,
          "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": 356.43,
          "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": 135.12,
      "maximum": 135.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 135.12,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 135.116,
          "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": 772.1,
      "maximum": 1414.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 772.10406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 772.10406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1008.544446,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1414.11,
          "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": 1414.11,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 2395.94,
      "maximum": 2395.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2395.94355,
          "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": 64.9,
      "maximum": 131.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.901655,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.46,
          "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": 131.46,
          "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": 71.78,
      "maximum": 131.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.46,
          "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": 131.46,
          "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": 133.1,
      "maximum": 243.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 133.09842,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 133.09842,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 178.171812,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 243.77,
          "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": 243.77,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "4VHPV VACCINE 3 DOSE IM",
  "code_information": [
    {
      "code": "90649",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 163.24,
      "maximum": 163.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 163.2425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 163.24,
          "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": 4.85,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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/water",
  "code_information": [
    {
      "code": "J7060",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.2,
      "maximum": 4.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.3775,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.2,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABACAVIR SULFATE 20 MG/ML PO SOLN",
  "drug_information": {
    "unit": 240.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "64980040524",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 54.51,
      "maximum": 204.97,
      "gross_charge": 218.05,
      "discounted_cash": 119.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 147.8379,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 119.0553,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 204.967,
          "standard_charge_percentage": 94.0,
          "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": 63.910455,
          "standard_charge_percentage": 29.31,
          "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": 79.89352,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 119.0553,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 174.44,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 184.9064,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 185.3425,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 194.0645,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 194.0645,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 195.15475,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 195.15475,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 124.2885,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 196.245,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 196.245,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 119.0553,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 204.967,
          "standard_charge_percentage": 94.0,
          "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": 103.57375,
          "standard_charge_percentage": 47.5,
          "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": 54.5125,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABACAVIR SULFATE 300 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68084002121",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.26,
      "maximum": 8.51,
      "gross_charge": 9.05,
      "discounted_cash": 4.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.1359,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.9413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.507,
          "standard_charge_percentage": 94.0,
          "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": 3.31592,
          "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": 2.652555,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7.6744,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.9413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7.24,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.6925,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.0545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.0545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.09975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.09975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.1585,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.9413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.507,
          "standard_charge_percentage": 94.0,
          "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": 4.29875,
          "standard_charge_percentage": 47.5,
          "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": 2.2625,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65862033530",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "49702023113",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 106.03,
      "maximum": 398.65,
      "gross_charge": 424.1,
      "discounted_cash": 233.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 287.5398,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 231.5586,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 398.654,
          "standard_charge_percentage": 94.0,
          "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": 124.30371,
          "standard_charge_percentage": 29.31,
          "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": 155.39024,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 339.28,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 231.5586,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 359.6368,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 360.485,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 377.449,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 377.449,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 379.5695,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 379.5695,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 241.737,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 381.69,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 381.69,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 231.5586,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 398.654,
          "standard_charge_percentage": 94.0,
          "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": 201.4475,
          "standard_charge_percentage": 47.5,
          "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": 106.025,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABATACEPT 125 MG/ML SC SOSY",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00003218811",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 24.44,
      "maximum": 3636.54,
      "gross_charge": 3868.66,
      "discounted_cash": 2127.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2622.95148,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.43896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3636.5404,
          "standard_charge_percentage": 94.0,
          "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": 1133.904246,
          "standard_charge_percentage": 29.31,
          "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": 1417.477024,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.43896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3280.62368,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3094.928,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3288.361,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3443.1074,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3443.1074,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3462.4507,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3462.4507,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2205.1362,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3481.794,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3481.794,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.019624,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3636.5404,
          "standard_charge_percentage": 94.0,
          "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": 1837.6135,
          "standard_charge_percentage": 47.5,
          "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": 44.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABATACEPT 125 MG/ML SC SOSY|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00003218811_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 24.44,
      "maximum": 3636.54,
      "gross_charge": 3868.66,
      "discounted_cash": 2127.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2622.95148,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.43896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3636.5404,
          "standard_charge_percentage": 94.0,
          "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": 1417.477024,
          "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": 1133.904246,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.43896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3094.928,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3280.62368,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3288.361,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3443.1074,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3443.1074,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3462.4507,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3462.4507,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2205.1362,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3481.794,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3481.794,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.019624,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3636.5404,
          "standard_charge_percentage": 94.0,
          "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": 1837.6135,
          "standard_charge_percentage": 47.5,
          "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": 44.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABATACEPT 250 MG IV SOLR",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00003218713",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 24.44,
      "maximum": 3735.29,
      "gross_charge": 3973.71,
      "discounted_cash": 2185.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2694.17538,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.43896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3735.2874,
          "standard_charge_percentage": 94.0,
          "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": 1164.694401,
          "standard_charge_percentage": 29.31,
          "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": 1455.967344,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.43896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 61.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "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": "No payer specific notes",
          "standard_charge_dollar": 3377.6535,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3536.6019,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3536.6019,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3556.47045,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3556.47045,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2265.0147,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3576.339,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3576.339,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.019624,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3735.2874,
          "standard_charge_percentage": 94.0,
          "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": 1887.51225,
          "standard_charge_percentage": 47.5,
          "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": 44.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Abciximab injection",
  "code_information": [
    {
      "code": "J0130",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1375.15,
      "maximum": 1375.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1375.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1375.147,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ABD PARACENTESIS",
  "code_information": [
    {
      "code": "49082",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 505.94,
      "maximum": 926.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 505.93998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 505.93998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 691.075476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 926.63,
          "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": 926.63,
          "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": 505.94,
      "maximum": 926.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 505.93998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 505.93998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 691.075476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 926.63,
          "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": 926.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABETA42 & PTAU181 ECLIA CSF",
  "code_information": [
    {
      "code": "0445U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 142.23,
      "maximum": 260.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 192.01455,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 142.23,
      "maximum": 260.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 192.01455,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABIRATERONE ACETATE 250 MG PO TABS",
  "drug_information": {
    "unit": 4.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687079021",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.84,
      "maximum": 21.96,
      "gross_charge": 23.36,
      "discounted_cash": 12.85,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.83808,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.75456,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.9584,
          "standard_charge_percentage": 94.0,
          "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": 6.846816,
          "standard_charge_percentage": 29.31,
          "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": 8.559104,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 19.80928,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 18.688,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.75456,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.856,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.7904,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.7904,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.9072,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.9072,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.3152,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.024,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.024,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.75456,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.9584,
          "standard_charge_percentage": 94.0,
          "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": 11.096,
          "standard_charge_percentage": 47.5,
          "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": 5.84,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABL1 GENE",
  "code_information": [
    {
      "code": "81170",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 163.8,
      "maximum": 300.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.13,
          "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": 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": 4047.71,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "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": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "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": 5929.6,
      "maximum": 10860.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7674.110262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10860.07,
          "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": 10860.07,
          "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": 3372.35,
      "maximum": 6176.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3372.35262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3372.35262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4300.506756,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6176.47,
          "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": 6176.47,
          "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": 2184.13,
      "maximum": 4000.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2184.13104,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2184.13104,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4000.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4000.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLT IRE 1+ O/T LV/PRST8 PRQ",
  "code_information": [
    {
      "code": "0600T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5929.6,
      "maximum": 10860.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7674.110262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10860.07,
          "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": 10860.07,
          "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": 2184.13,
      "maximum": 4000.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2184.13104,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2184.13104,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4000.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4000.24,
          "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": 7359.65,
      "maximum": 13479.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7359.65412,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7359.65412,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9576.712782,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13479.22,
          "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": 13479.22,
          "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": 921.3,
      "maximum": 1687.37,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 921.30402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 921.30402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1194.278904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1687.37,
          "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": 1687.37,
          "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": 5280.64,
      "maximum": 9671.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5280.639,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5280.639,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9671.5,
          "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": 9671.5,
          "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": 921.3,
      "maximum": 1687.37,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 921.30402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 921.30402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1194.278904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1687.37,
          "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": 1687.37,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ IRE 1+TUMORS OPEN",
  "code_information": [
    {
      "code": "0601T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5929.6,
      "maximum": 10860.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7674.110262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10860.07,
          "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": 10860.07,
          "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": 5929.6,
      "maximum": 10860.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10860.07,
          "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": 10860.07,
          "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": 5929.6,
      "maximum": 10860.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5929.59822,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10860.07,
          "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": 10860.07,
          "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": 2184.13,
      "maximum": 4000.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2184.13104,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2184.13104,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2822.562288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4000.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4000.24,
          "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": 5280.64,
      "maximum": 9671.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5280.639,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5280.639,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6816.074265,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9671.5,
          "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": 9671.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ PERC LXTR/PERPH NRV",
  "code_information": [
    {
      "code": "0441T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1089.28,
      "maximum": 1995.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1089.28092,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1089.28092,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1439.386767,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.02,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ PERC PLEX/TRNCL NRV",
  "code_information": [
    {
      "code": "0442T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4720.44,
      "maximum": 8965.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4895.39778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4895.39778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4720.439997,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8965.93,
          "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": 8965.93,
          "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": 1089.28,
      "maximum": 1995.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1089.28092,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1089.28092,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1439.386767,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.02,
          "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": 150.06,
      "maximum": 274.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 150.05718,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 150.05718,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 202.577193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 150.06,
      "maximum": 274.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 150.05718,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 150.05718,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 202.577193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 300 UNITS IM SOLR",
  "drug_information": {
    "unit": 300.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "15054053006",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.8,
      "maximum": 1938.28,
      "gross_charge": 2062.0,
      "discounted_cash": 1134.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1398.036,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.79934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1938.28,
          "standard_charge_percentage": 94.0,
          "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": 755.5168,
          "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": 604.3722,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.79934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.9845,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1752.7,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1835.18,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1835.18,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1845.49,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1845.49,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1175.34,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1855.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1855.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.361173,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1938.28,
          "standard_charge_percentage": 94.0,
          "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": 979.45,
          "standard_charge_percentage": 47.5,
          "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": 8.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABOBOTULINUMTOXINA 500 UNITS IM SOLR",
  "drug_information": {
    "unit": 500.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "15054050001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.8,
      "maximum": 3229.84,
      "gross_charge": 3436.0,
      "discounted_cash": 1889.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2329.608,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.79934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3229.84,
          "standard_charge_percentage": 94.0,
          "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": 1258.9504,
          "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": 1007.0916,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.79934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": "No payer specific notes",
          "standard_charge_dollar": 2920.6,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3058.04,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3058.04,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3075.22,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3075.22,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1958.52,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3092.4,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3092.4,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.361173,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3229.84,
          "standard_charge_percentage": 94.0,
          "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": 1632.1,
          "standard_charge_percentage": 47.5,
          "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": 8.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABORTION (MPR)",
  "code_information": [
    {
      "code": "59866",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 169.99,
      "maximum": 311.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 169.98618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 169.98618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 224.218449,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 311.33,
          "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": 311.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABRASION LESION SINGLE",
  "code_information": [
    {
      "code": "15786",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 111.92,
      "maximum": 204.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.91908,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.91908,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 146.46177,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.98,
          "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": 204.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Absolv3 per sq cm",
  "code_information": [
    {
      "code": "Q4401",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABSORBABLE HEMOSTAT",
  "drug_information": {
    "unit": 5.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "82526100005",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 139.21,
      "maximum": 523.44,
      "gross_charge": 556.85,
      "discounted_cash": 306.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 377.5443,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 304.0401,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 523.439,
          "standard_charge_percentage": 94.0,
          "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": 204.02984,
          "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": 163.212735,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 304.0401,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 472.2088,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 445.48,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 473.3225,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 495.5965,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 495.5965,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 511.1883,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 498.38075,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 317.4045,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 501.165,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 501.165,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 304.0401,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 523.439,
          "standard_charge_percentage": 94.0,
          "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": 264.50375,
          "standard_charge_percentage": 47.5,
          "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": 139.2125,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABSORBASE EX OINT",
  "drug_information": {
    "unit": 454.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "46287050716",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.86,
      "maximum": 48.34,
      "gross_charge": 51.43,
      "discounted_cash": 28.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.86954,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.08078,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 48.3442,
          "standard_charge_percentage": 94.0,
          "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": 18.843952,
          "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": 15.074133,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 43.61264,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 41.144,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.08078,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.7155,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.7727,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.7727,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.02985,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.02985,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.3151,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.287,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.287,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.08078,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.3442,
          "standard_charge_percentage": 94.0,
          "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": 24.42925,
          "standard_charge_percentage": 47.5,
          "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": 12.8575,
          "standard_charge_percentage": 25.0,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN",
  "drug_information": {
    "unit": 750.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "14537081775",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN (ADULT CRRT)",
  "drug_information": {
    "unit": 750.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "14537081775_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN (APHERESIS)",
  "drug_information": {
    "unit": 750.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "14537081775_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN (PEDS CRRT NXSTAGE)",
  "drug_information": {
    "unit": 750.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "14537081775_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN (PEDS CRRT PRISMAFLEX)",
  "drug_information": {
    "unit": 750.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "14537081775_5",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acesso tl, per sq cm",
  "code_information": [
    {
      "code": "Q4300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acesso trifaca per sq cm",
  "code_information": [
    {
      "code": "Q4386",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 10 MG/ML 0-50 ML SYRINGE",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00264410090_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.1,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 10 MG/ML 0-50 ML SYRINGE (2 DAY MAX DURATION)",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00264410090_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.1,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 10 MG/ML 50-100 ML INTRAVIA",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00264410090_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.1,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 10 MG/ML 50-100 ML INTRAVIA (2 DAY MAX DURATION)",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00264410090_5",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.1,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 10 MG/ML IV SOLN",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00264410090_6",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.1,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 10 MG/ML IV SOLN (2 DAY MAX DURATION)",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00264410090_7",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.1,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 10 MG/ML SYRINGE (NICU)",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00264410090",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.1,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 120 MG RE SUPP",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "51672211502",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 32 MG/ML PO LIQUID",
  "drug_information": {
    "unit": 2.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68094013058",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 325 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50580045811",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 325 MG RE SUPP",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "51672211602",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 500 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00904673061",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 650 MG RE SUPP",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "45802073032",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN 80 MG PO CHEW",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00904579146",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN",
  "drug_information": {
    "unit": 15.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "1785607901",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.3,
      "maximum": 12.42,
      "gross_charge": 13.21,
      "discounted_cash": 7.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.95638,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.21266,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.4174,
          "standard_charge_percentage": 94.0,
          "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": 4.840144,
          "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": 3.871851,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 11.20208,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.21266,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 10.568,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.2285,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.7569,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.7569,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.82295,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.82295,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.5297,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.889,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.889,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.21266,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.4174,
          "standard_charge_percentage": 94.0,
          "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": 6.27475,
          "standard_charge_percentage": 47.5,
          "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": 3.3025,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN-CODEINE 300-30 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00406048462",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "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": 2.9312,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAMINOPHEN-CODEINE 300-60 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "1310706001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.9312,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAZOLAMIDE 100 MG/ML SYRINGE(PEDS)",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "09992019007",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 32.33,
      "maximum": 121.57,
      "gross_charge": 129.33,
      "discounted_cash": 71.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 87.68574,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 70.61418,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.5702,
          "standard_charge_percentage": 94.0,
          "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": 47.386512,
          "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": 37.906623,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 103.464,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 70.61418,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 109.67184,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 109.9305,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 115.1037,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 115.1037,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 115.75035,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 115.75035,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 73.7181,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 116.397,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 116.397,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 70.61418,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 121.5702,
          "standard_charge_percentage": 94.0,
          "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": 61.43175,
          "standard_charge_percentage": 47.5,
          "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": 32.3325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAZOLAMIDE 250 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50268005415",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.07,
      "maximum": 4.0,
      "gross_charge": 4.26,
      "discounted_cash": 2.34,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.88828,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.32596,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.0044,
          "standard_charge_percentage": 94.0,
          "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": 1.560864,
          "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": 1.248606,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.32596,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.61248,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.408,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.621,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.7914,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.7914,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.8127,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.8127,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.4282,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.834,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.834,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.32596,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.0044,
          "standard_charge_percentage": 94.0,
          "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": 2.0235,
          "standard_charge_percentage": 47.5,
          "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": 1.065,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAZOLAMIDE 25MG/ML ORAL SUSPENSION",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P5167240231",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.02,
      "maximum": 3.82,
      "gross_charge": 4.06,
      "discounted_cash": 2.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.75268,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.21676,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.8164,
          "standard_charge_percentage": 94.0,
          "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": 1.487584,
          "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": 1.189986,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.21676,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.44288,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.248,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.451,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6134,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6134,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6337,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6337,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.3142,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.654,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.654,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.21676,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.8164,
          "standard_charge_percentage": 94.0,
          "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": 1.9285,
          "standard_charge_percentage": 47.5,
          "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": 1.015,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAZOLAMIDE ER 500 MG PO CP12",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687057821",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.9,
      "maximum": 7.15,
      "gross_charge": 7.61,
      "discounted_cash": 4.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.15958,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.15506,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.1534,
          "standard_charge_percentage": 94.0,
          "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": 2.788304,
          "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": 2.230491,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.45328,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.088,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.15506,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.4685,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.7729,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.7729,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.81095,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.81095,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.3377,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.849,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.849,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.15506,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.1534,
          "standard_charge_percentage": 94.0,
          "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": 3.61475,
          "standard_charge_percentage": 47.5,
          "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": 1.9025,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETAZOLAMIDE SODIUM 500 MG IJ SOLR",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "39822019001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.56,
      "maximum": 62.28,
      "gross_charge": 66.25,
      "discounted_cash": 36.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 44.9175,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.1725,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.275,
          "standard_charge_percentage": 94.0,
          "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": 19.417875,
          "standard_charge_percentage": 29.31,
          "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": 24.274,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.1725,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.7115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 56.3125,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58.9625,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58.9625,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.29375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.29375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.7625,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.625,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.625,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.1725,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.275,
          "standard_charge_percentage": 94.0,
          "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": 31.46875,
          "standard_charge_percentage": 47.5,
          "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": 16.5625,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETIC ACID 0.25 % IR SOLN",
  "drug_information": {
    "unit": 1000.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00338065604",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETIC ACID 2 % OT SOLN",
  "drug_information": {
    "unit": 15.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "52817081615",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.26,
      "maximum": 38.57,
      "gross_charge": 41.03,
      "discounted_cash": 22.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.81834,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.40238,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 38.5682,
          "standard_charge_percentage": 94.0,
          "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": 12.025893,
          "standard_charge_percentage": 29.31,
          "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": 15.033392,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 34.79344,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.40238,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.824,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.8755,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.5167,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.5167,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72185,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72185,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.3871,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.927,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.927,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.40238,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.5682,
          "standard_charge_percentage": 94.0,
          "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": 19.48925,
          "standard_charge_percentage": 47.5,
          "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": 10.2575,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETIC ACID 3 % SOLN",
  "drug_information": {
    "unit": 30.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P8252005130",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.672,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETIC ACID 5% SOLN",
  "drug_information": {
    "unit": 60.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P4444075330",
      "type": "NDC"
    },
    {
      "code": "P4444075360",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.672,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETYLCHOLINE CHLORIDE 20 MG IO SOLR",
  "drug_information": {
    "unit": 0.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "24208053920",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18.21,
      "maximum": 68.45,
      "gross_charge": 72.82,
      "discounted_cash": 40.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 49.37196,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.75972,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 68.4508,
          "standard_charge_percentage": 94.0,
          "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": 26.681248,
          "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": 21.343542,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 58.256,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 61.75136,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.75972,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.897,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.8098,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.8098,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.84876,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.1739,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 41.5074,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.538,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.538,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.75972,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 68.4508,
          "standard_charge_percentage": 94.0,
          "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": 34.5895,
          "standard_charge_percentage": 47.5,
          "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": 18.205,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETYLCHOLINE INTRACORONARY SYRINGE",
  "drug_information": {
    "unit": 12.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "09991000125",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 65.46,
      "maximum": 246.14,
      "gross_charge": 261.85,
      "discounted_cash": 144.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 177.5343,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.9701,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 246.139,
          "standard_charge_percentage": 94.0,
          "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": 76.748235,
          "standard_charge_percentage": 29.31,
          "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": 95.94184,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.9701,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 222.0488,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 209.48,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 222.5725,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 233.0465,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 233.0465,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 234.35575,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 240.3783,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 149.2545,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 235.665,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 235.665,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.9701,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 246.139,
          "standard_charge_percentage": 94.0,
          "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": 124.37875,
          "standard_charge_percentage": 47.5,
          "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": 65.4625,
          "standard_charge_percentage": 25.0,
          "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": 6.71,
      "maximum": 12.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.71034,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.71034,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.058959,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 10.05,
      "maximum": 18.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.0464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.0464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.56264,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 10.05,
      "maximum": 18.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.0464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.0464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.56264,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 6.58,
      "maximum": 12.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.882055,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 20 % IN SOLN",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00517760425_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.34,
      "maximum": 8.78,
      "gross_charge": 9.34,
      "discounted_cash": 5.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.33252,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.09964,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.7796,
          "standard_charge_percentage": 94.0,
          "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": 2.737554,
          "standard_charge_percentage": 29.31,
          "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": 3.422176,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7.92032,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7.472,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.09964,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.939,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.3126,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.3126,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.3593,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.3593,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.3238,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.406,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.406,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.09964,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.7796,
          "standard_charge_percentage": 94.0,
          "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": 4.4365,
          "standard_charge_percentage": 47.5,
          "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": 2.335,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETYLCYSTEINE 20 % IN SOLN (INHALATION)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00517760425",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETYLCYSTEINE 200 MG/ML IV SOLN",
  "drug_information": {
    "unit": 30.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "72611086004",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.43,
      "maximum": 78.75,
      "gross_charge": 83.78,
      "discounted_cash": 46.08,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.80284,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.74388,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 78.7532,
          "standard_charge_percentage": 94.0,
          "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": 30.696992,
          "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": 24.555918,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.74388,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 71.213,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.5642,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.5642,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.9831,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.9831,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.7546,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.402,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.402,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.74388,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 78.7532,
          "standard_charge_percentage": 94.0,
          "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": 39.7955,
          "standard_charge_percentage": 47.5,
          "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": 20.945,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETYLCYSTEINE OPHTHALMIC SOLN 20%",
  "drug_information": {
    "unit": 12.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252000247",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.98,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACHR ANTB ID IMFLUOR LIVECLL",
  "code_information": [
    {
      "code": "0545U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.6,
      "maximum": 37.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.60058,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.60058,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 208.16,
      "maximum": 391.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.15704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.15704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.10526,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACITRETIN 10 MG PO CAPS",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "42794008008",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 42.39,
      "maximum": 159.39,
      "gross_charge": 169.56,
      "discounted_cash": 93.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 114.96168,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 92.57976,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 159.3864,
          "standard_charge_percentage": 94.0,
          "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": 62.126784,
          "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": 49.698036,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 143.78688,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 92.57976,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 135.648,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 144.126,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 150.9084,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 150.9084,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 151.7562,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 151.7562,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 96.6492,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 152.604,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 152.604,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 92.57976,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 159.3864,
          "standard_charge_percentage": 94.0,
          "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": 80.541,
          "standard_charge_percentage": 47.5,
          "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": 42.39,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACITRETIN 25 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "42794008308",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17.42,
      "maximum": 65.49,
      "gross_charge": 69.67,
      "discounted_cash": 38.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.23626,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.03982,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.4898,
          "standard_charge_percentage": 94.0,
          "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": 20.420277,
          "standard_charge_percentage": 29.31,
          "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": 25.527088,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 55.736,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 59.08016,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.03982,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.2195,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.0063,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.0063,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.35465,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.35465,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 39.7119,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.703,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.703,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.03982,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.4898,
          "standard_charge_percentage": 94.0,
          "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": 33.09325,
          "standard_charge_percentage": 47.5,
          "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": 17.4175,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACOUSTIC IMMITANCE TESTING",
  "code_information": [
    {
      "code": "92570",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 71.78,
      "maximum": 131.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115.326666,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.46,
          "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": 131.46,
          "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": 20.84,
      "maximum": 38.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.931175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.16,
          "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": 38.16,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACTH STIMULATION PANEL",
  "code_information": [
    {
      "code": "80400",
      "type": "HCPCS"
    },
    {
      "code": "80402",
      "type": "HCPCS"
    },
    {
      "code": "80406",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17.81,
      "maximum": 86.96,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.81052,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.48016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.72996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.81052,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.48016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.72996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.044202,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.098216,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.685446,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ACTIDOSE WITH SORBITOL 25 GM/120ML PO SUSP",
  "drug_information": {
    "unit": 120.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "66689020304",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.05,
      "maximum": 37.77,
      "gross_charge": 40.18,
      "discounted_cash": 22.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.24204,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.93828,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.7692,
          "standard_charge_percentage": 94.0,
          "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": 11.776758,
          "standard_charge_percentage": 29.31,
          "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": 14.721952,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 34.07264,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.93828,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.144,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.153,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.7602,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.7602,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.9611,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.9611,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.9026,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.162,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.162,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.93828,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.7692,
          "standard_charge_percentage": 94.0,
          "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": 19.0855,
          "standard_charge_percentage": 47.5,
          "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": 10.045,
          "standard_charge_percentage": 25.0,
          "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": 32.91,
      "maximum": 60.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.90742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.90742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.78374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.27,
          "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": 60.27,
          "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": 6.58,
      "maximum": 12.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.882055,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 20.84,
      "maximum": 38.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.931175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.16,
          "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": 38.16,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Activate matrix, per sq cm",
  "code_information": [
    {
      "code": "Q4301",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACTIVE THRC IRRIGATION SPX",
  "code_information": [
    {
      "code": "1021T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 349.93,
      "maximum": 640.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 349.92594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 349.92594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 640.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 640.89,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUP 1/> W/ESTIM 1ST 15 MIN",
  "code_information": [
    {
      "code": "97813",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.13,
      "maximum": 29.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.051579,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUP 1/> WO ESTIM 1ST 15 MIN",
  "code_information": [
    {
      "code": "97810",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.13,
      "maximum": 29.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.051579,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE GI BLOOD LOSS IMAGING",
  "code_information": [
    {
      "code": "78278",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 223.0,
      "maximum": 408.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 223.00278,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 223.00278,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 296.188893,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 408.43,
          "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": 408.43,
          "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": 26.01,
      "maximum": 47.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.00598,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.00598,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.108073,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 VENOUS THROMBUS IMAGE",
  "code_information": [
    {
      "code": "78456",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 722.19,
      "maximum": 1322.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 722.18874,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 722.18874,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 962.269308,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1322.69,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1322.69,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACYCLOVIR 200 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00904578961",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACYCLOVIR 200 MG/5ML PO SUSP",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "2315548551",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACYCLOVIR 400 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50268006115",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACYCLOVIR 5 % EX OINT",
  "drug_information": {
    "unit": 15.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "72578008201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.99,
      "maximum": 33.79,
      "gross_charge": 35.95,
      "discounted_cash": 19.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.3741,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.6287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.793,
          "standard_charge_percentage": 94.0,
          "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": 10.536945,
          "standard_charge_percentage": 29.31,
          "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": 13.17208,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 28.76,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.6287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 30.4856,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.5575,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.9955,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.9955,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.17525,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.17525,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20.4915,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.355,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.355,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.6287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.793,
          "standard_charge_percentage": 94.0,
          "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": 17.07625,
          "standard_charge_percentage": 47.5,
          "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": 8.9875,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACYCLOVIR 800 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68084010901",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACYCLOVIR SODIUM 50 MG/ML IV SOLN",
  "drug_information": {
    "unit": 20.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "55150015520",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.12,
      "maximum": 44.7,
      "gross_charge": 47.55,
      "discounted_cash": 26.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.2389,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.9623,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 44.697,
          "standard_charge_percentage": 94.0,
          "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": 13.936905,
          "standard_charge_percentage": 29.31,
          "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": 17.42232,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.12,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.9623,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.119,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.4175,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.3195,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.3195,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.55725,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.55725,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.1035,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.795,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.795,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.9623,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.697,
          "standard_charge_percentage": 94.0,
          "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": 22.58625,
          "standard_charge_percentage": 47.5,
          "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": 11.8875,
          "standard_charge_percentage": 25.0,
          "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": 9.0,
      "maximum": 16.49,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.00354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.00354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.154779,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 9.21,
      "maximum": 16.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.434877,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ADALIMUMAB 20 MG/0.2ML SC PSKT",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00074061602",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 67.61,
      "maximum": 8840.45,
      "gross_charge": 9404.73,
      "discounted_cash": 5172.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6376.40694,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8840.4462,
          "standard_charge_percentage": 94.0,
          "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": 2756.526363,
          "standard_charge_percentage": 29.31,
          "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": 3445.893072,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7523.784,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7975.21104,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7994.0205,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8370.2097,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8370.2097,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8417.23335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8417.23335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5360.6961,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8464.257,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8464.257,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.614183,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8840.4462,
          "standard_charge_percentage": 94.0,
          "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": 4467.24675,
          "standard_charge_percentage": 47.5,
          "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": 2351.1825,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADALIMUMAB 40 MG/0.4ML SC PSKT",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00074024302",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 67.61,
      "maximum": 8840.45,
      "gross_charge": 9404.73,
      "discounted_cash": 5172.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6376.40694,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8840.4462,
          "standard_charge_percentage": 94.0,
          "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": 3445.893072,
          "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": 2756.526363,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7975.21104,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7523.784,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7994.0205,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8370.2097,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8370.2097,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8417.23335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8417.23335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5360.6961,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8464.257,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8464.257,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.614183,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8840.4462,
          "standard_charge_percentage": 94.0,
          "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": 4467.24675,
          "standard_charge_percentage": 47.5,
          "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": 2351.1825,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADALIMUMAB 40 MG/0.8ML SC AJKT",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00074433902",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 67.61,
      "maximum": 8840.45,
      "gross_charge": 9404.73,
      "discounted_cash": 5172.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6376.40694,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8840.4462,
          "standard_charge_percentage": 94.0,
          "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": 2756.526363,
          "standard_charge_percentage": 29.31,
          "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": 3445.893072,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7975.21104,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7523.784,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7994.0205,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8370.2097,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8370.2097,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8417.23335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8417.23335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5360.6961,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8464.257,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8464.257,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.614183,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8840.4462,
          "standard_charge_percentage": 94.0,
          "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": 4467.24675,
          "standard_charge_percentage": 47.5,
          "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": 2351.1825,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADALIMUMAB 40 MG/0.8ML SC PSKT",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00074379902",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2351.18,
      "maximum": 8840.45,
      "gross_charge": 9404.73,
      "discounted_cash": 5172.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6376.40694,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8840.4462,
          "standard_charge_percentage": 94.0,
          "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": 3445.893072,
          "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": 2756.526363,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7975.21104,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7523.784,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7994.0205,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8370.2097,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8370.2097,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8417.23335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8417.23335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5360.6961,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8464.257,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8464.257,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5134.98258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8840.4462,
          "standard_charge_percentage": 94.0,
          "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": 4467.24675,
          "standard_charge_percentage": 47.5,
          "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": 2351.1825,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADALIMUMAB 80 MG/0.8ML SC AJKT",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00074012402",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4702.38,
      "maximum": 17680.94,
      "gross_charge": 18809.51,
      "discounted_cash": 10345.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12752.84778,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10269.99246,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 17680.9394,
          "standard_charge_percentage": 94.0,
          "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": 6891.804464,
          "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": 5513.067381,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 15950.46448,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 15047.608,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10269.99246,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15988.0835,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16740.4639,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16740.4639,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16834.51145,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16834.51145,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10721.4207,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16928.559,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16928.559,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10269.99246,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17680.9394,
          "standard_charge_percentage": 94.0,
          "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": 8934.51725,
          "standard_charge_percentage": 47.5,
          "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": 4702.3775,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADALIMUMAB-ATTO 40 MG/0.8ML SC SOAJ",
  "drug_information": {
    "unit": 0.8,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "72511040001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1133.15,
      "maximum": 4260.65,
      "gross_charge": 4532.61,
      "discounted_cash": 2492.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3073.10958,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2474.80506,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4260.6534,
          "standard_charge_percentage": 94.0,
          "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": 1328.507991,
          "standard_charge_percentage": 29.31,
          "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": 1660.748304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3843.65328,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2474.80506,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3626.088,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3852.7185,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4034.0229,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4034.0229,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4056.68595,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4056.68595,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2583.5877,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4079.349,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4079.349,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2474.80506,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4260.6534,
          "standard_charge_percentage": 94.0,
          "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": 2152.98975,
          "standard_charge_percentage": 47.5,
          "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": 1133.1525,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADAPT BEHAVIOR TX PHYS/QHP",
  "code_information": [
    {
      "code": "97155",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 99.01,
      "maximum": 181.34,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 99.01164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 99.01164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 118.429857,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 181.34,
          "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": 181.34,
          "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": 20.9,
      "maximum": 38.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.958209,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "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": 56.67,
      "maximum": 103.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.18175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103.79,
          "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": 103.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Add proc construct new crown",
  "code_information": [
    {
      "code": "D2971",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADDING WALKER TO PREV CAST",
  "code_information": [
    {
      "code": "29440",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADEFOVIR DIPIVOXIL 10 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "42794000308",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.39,
      "maximum": 46.6,
      "gross_charge": 49.57,
      "discounted_cash": 27.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.60846,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.06522,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 46.5958,
          "standard_charge_percentage": 94.0,
          "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": 14.528967,
          "standard_charge_percentage": 29.31,
          "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": 18.162448,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.06522,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 39.656,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 42.03536,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.1345,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.1173,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.1173,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.36515,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.36515,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.2549,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.613,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.613,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.06522,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.5958,
          "standard_charge_percentage": 94.0,
          "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": 23.54575,
          "standard_charge_percentage": 47.5,
          "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": 12.3925,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN",
  "drug_information": {
    "unit": 30.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "55150019301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.88,
      "maximum": 426.12,
      "gross_charge": 453.32,
      "discounted_cash": 249.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 307.35096,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 247.51272,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 426.1208,
          "standard_charge_percentage": 94.0,
          "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": 166.096448,
          "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": 132.868092,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 247.51272,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": "No payer specific notes",
          "standard_charge_dollar": 385.322,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 403.4548,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 403.4548,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 405.7214,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 405.7214,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 258.3924,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 407.988,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 407.988,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 247.51272,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 426.1208,
          "standard_charge_percentage": 94.0,
          "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": 215.327,
          "standard_charge_percentage": 47.5,
          "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": 113.33,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADENOSINE 6 MG/2ML IV SOLN",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "67457085502",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.88,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADENOVIRUS AG IA",
  "code_information": [
    {
      "code": "87301",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.54,
      "maximum": 11.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.54108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.54108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.830458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 7.88,
      "maximum": 14.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.87878,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.87878,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.636353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 7.03,
      "maximum": 12.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.02702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.02702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.486477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 11.88,
      "maximum": 21.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.88096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.88096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.039296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ADJMT/REVJ EXT FIXJ SYS ANES",
  "code_information": [
    {
      "code": "20693",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adm of soc dtr assess 5-15 m",
  "code_information": [
    {
      "code": "G0136",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.9,
      "maximum": 38.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.958209,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "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": 245.97,
      "maximum": 450.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 245.973,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 245.973,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 332.06355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 450.5,
          "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": 450.5,
          "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": 245.97,
      "maximum": 450.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 245.973,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 245.973,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 332.06355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 450.5,
          "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": 450.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Admin hepatitis b vaccine",
  "code_information": [
    {
      "code": "G0010",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 26.12,
      "maximum": 47.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.009794,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "Admin influenza virus vac",
  "code_information": [
    {
      "code": "G0008",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 26.12,
      "maximum": 47.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.009794,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "Admin pneumococcal vaccine",
  "code_information": [
    {
      "code": "G0009",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 26.12,
      "maximum": 47.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.009794,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ADMN SARSCOV2 VAC 1/ONLY CMP",
  "code_information": [
    {
      "code": "90480",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22.67,
      "maximum": 41.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.66992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.4215,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.66992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.604392,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242008801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2948.0,
      "maximum": 11084.49,
      "gross_charge": 11792.01,
      "discounted_cash": 6485.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7994.98278,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6438.43746,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11084.4894,
          "standard_charge_percentage": 94.0,
          "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": 4320.592464,
          "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": 3456.238131,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6438.43746,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 9999.62448,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 9433.608,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10023.2085,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10494.8889,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10494.8889,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10553.84895,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10553.84895,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6721.4457,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10612.809,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10612.809,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6438.43746,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11084.4894,
          "standard_charge_percentage": 94.0,
          "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": 5601.20475,
          "standard_charge_percentage": 47.5,
          "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": 2948.0025,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ADRC THER PRTL RC TEAR",
  "code_information": [
    {
      "code": "0717T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1976.78,
      "maximum": 3620.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1976.78208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1976.78208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2698.500987,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3620.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3620.48,
          "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": 1976.78,
      "maximum": 3620.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1976.78208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1976.78208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2698.500987,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3620.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3620.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADRENAL CORTEX & MEDULLA IMG",
  "code_information": [
    {
      "code": "78075",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 722.19,
      "maximum": 1322.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 722.18874,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 722.18874,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 962.269308,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1322.69,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1322.69,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADRNL CORTCL TUM BCHM ASY 25",
  "code_information": [
    {
      "code": "0015M",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 712.73,
      "maximum": 1305.37,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 712.73202,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 712.73202,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 962.188227,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 TPN FEE (RX USE ONLY)",
  "drug_information": {
    "unit": 2000.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "9997088301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 237.5,
      "maximum": 893.0,
      "gross_charge": 950.0,
      "discounted_cash": 522.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 644.1,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.7,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 893.0,
          "standard_charge_percentage": 94.0,
          "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": 278.445,
          "standard_charge_percentage": 29.31,
          "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": 348.08,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 760.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 805.6,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.7,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 807.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 845.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 845.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 850.25,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 872.1,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 541.5,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 855.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 855.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.7,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 893.0,
          "standard_charge_percentage": 94.0,
          "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": 451.25,
          "standard_charge_percentage": 47.5,
          "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": 237.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Adv prim care mgmt lvl 1",
  "code_information": [
    {
      "code": "G0556",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.9,
      "maximum": 38.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.958209,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "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": 20.9,
      "maximum": 38.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.958209,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "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": 56.67,
      "maximum": 103.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.18175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103.79,
          "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": 103.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADVNCD CARE PLAN 30 MIN",
  "code_information": [
    {
      "code": "99497",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 56.67,
      "maximum": 103.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.18175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103.79,
          "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": 103.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Advograft dual per sq cm",
  "code_information": [
    {
      "code": "Q4382",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 120.45,
      "maximum": 229.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 120.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 120.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 229.53294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 220.6,
          "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": 220.6,
          "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": 120.45,
      "maximum": 229.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 120.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 120.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 229.53294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 220.6,
          "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": 220.6,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AEP THRSHLD EST MLT FREQ I&R",
  "code_information": [
    {
      "code": "92652",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 120.45,
      "maximum": 229.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 120.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 120.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 229.53294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 220.6,
          "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": 220.6,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 122.15,
      "maximum": 223.72,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.15112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.15112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 149.918769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 223.72,
          "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": 223.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Afamelanotide implant, 1 mg",
  "code_information": [
    {
      "code": "J7352",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1607.11,
      "maximum": 3213.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1607.10732,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3213.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1607.10732,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2117.931543,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Afamitresgene autoleucel",
  "code_information": [
    {
      "code": "Q2057",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 420758.52,
      "maximum": 770620.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 420758.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 420758.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "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": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 741540.0,
          "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": 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": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 150.06,
      "maximum": 274.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 150.05718,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 150.05718,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 202.577193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AFLIBERCEPT 2 MG/0.05ML IZ SOLN",
  "drug_information": {
    "unit": 0.05,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "61755000502",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 417.09,
      "maximum": 3476.67,
      "gross_charge": 3698.58,
      "discounted_cash": 2034.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2507.63724,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 417.0894,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3476.6652,
          "standard_charge_percentage": 94.0,
          "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": 1084.053798,
          "standard_charge_percentage": 29.31,
          "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": 1355.159712,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 417.0894,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 967.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3143.793,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3291.7362,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3291.7362,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3310.2291,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3310.2291,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2108.1906,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3328.722,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3328.722,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 605.881458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3476.6652,
          "standard_charge_percentage": 94.0,
          "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": 1756.8255,
          "standard_charge_percentage": 47.5,
          "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": 763.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AFLIBERCEPT 2 MG/0.05ML IZ SOSY",
  "drug_information": {
    "unit": 0.05,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "61755000501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 417.09,
      "maximum": 5217.0,
      "gross_charge": 5550.0,
      "discounted_cash": 3052.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3762.9,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 417.0894,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5217.0,
          "standard_charge_percentage": 94.0,
          "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": 1626.705,
          "standard_charge_percentage": 29.31,
          "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": 2033.52,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 967.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 417.0894,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "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": "No payer specific notes",
          "standard_charge_dollar": 4717.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4939.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4939.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4967.25,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4967.25,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3163.5,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4995.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4995.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 605.881458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5217.0,
          "standard_charge_percentage": 94.0,
          "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": 2636.25,
          "standard_charge_percentage": 47.5,
          "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": 763.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AFLIBERCEPT 8 MG/0.07ML IZ SOLN",
  "drug_information": {
    "unit": 0.07,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "61755005001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 167.61,
      "maximum": 5602.83,
      "gross_charge": 5960.46,
      "discounted_cash": 3278.25,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4041.19188,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 167.61108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5602.8324,
          "standard_charge_percentage": 94.0,
          "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": 2183.912544,
          "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": 1747.010826,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 341.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 167.61108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 348.211,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5066.391,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5304.8094,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5304.8094,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5334.6117,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5334.6117,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3397.4622,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5364.414,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5364.414,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 245.97027,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 306.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5602.8324,
          "standard_charge_percentage": 94.0,
          "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": 2831.2185,
          "standard_charge_percentage": 47.5,
          "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": 306.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Afluria vacc, 3 yrs & >, im",
  "code_information": [
    {
      "code": "Q2035",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.32,
      "maximum": 16.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "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": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.32,
          "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": 306.8,
      "maximum": 561.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 306.80286,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 306.80286,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 404.37306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 561.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 561.91,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AG DETECTION POLYVAL IF",
  "code_information": [
    {
      "code": "87300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.54,
      "maximum": 11.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.54108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.54108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.830458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 35 MG IV SOLR",
  "drug_information": {
    "unit": 7.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58468004001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5591.05,
      "maximum": 21022.34,
      "gross_charge": 22364.19,
      "discounted_cash": 12300.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15162.92082,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12210.84774,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21022.3386,
          "standard_charge_percentage": 94.0,
          "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": 6554.944089,
          "standard_charge_percentage": 29.31,
          "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": 8194.239216,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 16897.0,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 15948.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12210.84774,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19009.5615,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19904.1291,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19904.1291,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20015.95005,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20015.95005,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12747.5883,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20127.771,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20127.771,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12210.84774,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21022.3386,
          "standard_charge_percentage": 94.0,
          "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": 10622.99025,
          "standard_charge_percentage": 47.5,
          "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": 5591.0475,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AGALSIDASE BETA 5 MG IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58468004101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 798.59,
      "maximum": 3002.68,
      "gross_charge": 3194.34,
      "discounted_cash": 1756.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2165.76252,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1744.10964,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3002.6796,
          "standard_charge_percentage": 94.0,
          "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": 1170.406176,
          "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": 936.261054,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 2708.80032,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1744.10964,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 2555.472,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2715.189,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2842.9626,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2842.9626,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2858.9343,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2858.9343,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1820.7738,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2874.906,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2874.906,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1744.10964,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3002.6796,
          "standard_charge_percentage": 94.0,
          "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": 1517.3115,
          "standard_charge_percentage": 47.5,
          "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": 798.585,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Agalsidase beta injection",
  "code_information": [
    {
      "code": "J0180",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 125.75,
      "maximum": 230.31,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.74926,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.74926,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 228.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 164.756592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AGENT NOS ASSAY W/OPTIC",
  "code_information": [
    {
      "code": "87899",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.77,
      "maximum": 16.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.77422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.77422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.845197,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 3.81,
      "maximum": 6.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.81108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.81108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.144958,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "AI DS SLE ALYS 10 CYTOKINE",
  "code_information": [
    {
      "code": "0446U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 458.99,
      "maximum": 840.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 458.9949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 458.9949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 619.643115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 458.99,
      "maximum": 840.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 458.9949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 458.9949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 619.643115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 458.99,
      "maximum": 840.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 458.9949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 458.9949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 619.643115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 414.96,
      "maximum": 760.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 414.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 414.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 560.196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 2006.55,
      "maximum": 3675.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2006.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2006.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2708.8425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 207.87,
      "maximum": 380.72,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 207.87312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 207.87312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.628712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "AIR DISPLACMNT PLETHYSMOGRAP",
  "code_information": [
    {
      "code": "1002T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.13,
      "maximum": 29.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AIRWY RESIST BY OSCILLOMETRY",
  "code_information": [
    {
      "code": "94728",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 71.78,
      "maximum": 131.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115.326666,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.46,
          "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": 131.46,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALANINE AMINO (ALT) (SGPT)",
  "code_information": [
    {
      "code": "84460",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.89,
      "maximum": 5.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.8938,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.8938,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.90663,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ALBENDAZOLE 200 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "43598045202",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.21,
      "maximum": 12.07,
      "gross_charge": 12.84,
      "discounted_cash": 7.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.70552,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.01064,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.0696,
          "standard_charge_percentage": 94.0,
          "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": 4.704576,
          "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": 3.763404,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.01064,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 10.88832,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 10.272,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.914,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.4276,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.4276,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.4918,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.4918,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.3188,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.556,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.556,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.01064,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.0696,
          "standard_charge_percentage": 94.0,
          "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": 6.099,
          "standard_charge_percentage": 47.5,
          "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": 3.21,
          "standard_charge_percentage": 25.0,
          "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": 11.59,
      "maximum": 21.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.59158,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.59158,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.648633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Albumin (human),5%, 50ml",
  "code_information": [
    {
      "code": "P9041",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.79,
      "maximum": 10.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.79306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.79306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "No additional generic notes"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 25 % IV SOLN (MULTI-GPI)",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521609",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 201.16,
      "gross_charge": 214.0,
      "discounted_cash": 117.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 145.092,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 62.7234,
          "standard_charge_percentage": 29.31,
          "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": 78.4096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 181.472,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 171.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.9,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.98,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.844,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 101.65,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 25 % IV SOLN (MULTI-GPI) HRS",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521609_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 201.16,
      "gross_charge": 214.0,
      "discounted_cash": 117.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 145.092,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 62.7234,
          "standard_charge_percentage": 29.31,
          "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": 78.4096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 171.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 181.472,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.9,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.98,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.844,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 101.65,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 25 % IV SOLN 50ML VIAL (BULK CHARGE)",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521609_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 201.16,
      "gross_charge": 214.0,
      "discounted_cash": 117.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 145.092,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 62.7234,
          "standard_charge_percentage": 29.31,
          "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": 78.4096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 171.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 181.472,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.9,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.98,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.844,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 101.65,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 25 % IV SOLN FOR REPLACEMENT FLUIDS",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521609_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 201.16,
      "gross_charge": 214.0,
      "discounted_cash": 117.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 145.092,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 78.4096,
          "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": 62.7234,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 181.472,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 171.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.9,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.98,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.844,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 101.65,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 5 % IV SOLN",
  "drug_information": {
    "unit": 250.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521804",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 201.16,
      "gross_charge": 214.0,
      "discounted_cash": 117.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 145.092,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 62.7234,
          "standard_charge_percentage": 29.31,
          "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": 78.4096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 171.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 181.472,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.9,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.98,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.125268,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 101.65,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 5 % IV SOLN 250 ML BOTTLE (BULK CHARGE)",
  "drug_information": {
    "unit": 250.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 201.16,
      "gross_charge": 214.0,
      "discounted_cash": 117.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 145.092,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 62.7234,
          "standard_charge_percentage": 29.31,
          "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": 78.4096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 171.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 181.472,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.9,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.98,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.125268,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 101.65,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 5 % IV SOLN FOR REPLACEMENT FLUIDS",
  "drug_information": {
    "unit": 250.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521401_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 201.16,
      "gross_charge": 214.0,
      "discounted_cash": 117.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 145.092,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 62.7234,
          "standard_charge_percentage": 29.31,
          "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": 78.4096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 181.472,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 171.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.9,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.46,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 191.53,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.98,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.125268,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 201.16,
          "standard_charge_percentage": 94.0,
          "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": 101.65,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 5 % SOLN (APHERESIS DOSE)",
  "drug_information": {
    "unit": 500.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521402",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 235.0,
      "gross_charge": 250.0,
      "discounted_cash": 137.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 169.5,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 235.0,
          "standard_charge_percentage": 94.0,
          "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": 91.6,
          "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": 73.275,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 212.0,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 200.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 212.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 222.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 222.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.75,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.75,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 142.5,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.125268,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 235.0,
          "standard_charge_percentage": 94.0,
          "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": 118.75,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN HUMAN 5 % SOLN (APHERESIS)",
  "drug_information": {
    "unit": 500.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516521402_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.98,
      "maximum": 235.0,
      "gross_charge": 250.0,
      "discounted_cash": 137.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 169.5,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 235.0,
          "standard_charge_percentage": 94.0,
          "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": 91.6,
          "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": 73.275,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 200.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 212.0,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.97622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 212.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 222.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 222.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.75,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.75,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 142.5,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.125268,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 235.0,
          "standard_charge_percentage": 94.0,
          "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": 118.75,
          "standard_charge_percentage": 47.5,
          "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": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUMIN ISCHEMIA MODIFIED",
  "code_information": [
    {
      "code": "82045",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18.53,
      "maximum": 33.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.53124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.53124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.017174,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "Albuterol non-comp con",
  "code_information": [
    {
      "code": "J7611",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.36,
      "maximum": 0.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.357,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687039583",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00487990130",
      "type": "NDC"
    },
    {
      "code": "69374033005",
      "type": "NDC"
    },
    {
      "code": "73177014632",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    },
    {
      "minimum": 1.0,
      "maximum": 23.5,
      "gross_charge": 25.0,
      "discounted_cash": 13.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.95,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.5,
          "standard_charge_percentage": 94.0,
          "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": 7.3275,
          "standard_charge_percentage": 29.31,
          "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": 9.16,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 21.2,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 20.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.25,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.25,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.25,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.25,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.5,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.5,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.5,
          "standard_charge_percentage": 94.0,
          "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": 11.875,
          "standard_charge_percentage": 47.5,
          "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": 6.25,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    },
    {
      "minimum": 1.0,
      "maximum": 35.25,
      "gross_charge": 37.5,
      "discounted_cash": 20.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 25.425,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.475,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.25,
          "standard_charge_percentage": 94.0,
          "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": 10.99125,
          "standard_charge_percentage": 29.31,
          "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": 13.74,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 31.8,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 30.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.475,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.875,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.375,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.375,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.5625,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.5625,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.375,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.75,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.75,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.475,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.25,
          "standard_charge_percentage": 94.0,
          "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": 17.8125,
          "standard_charge_percentage": 47.5,
          "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": 9.375,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE (5MG/ML) IN NEBU 0.5 ML VIAL (BULK CHARGE)",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00487990130_2",
      "type": "NDC"
    },
    {
      "code": "69374033005_2",
      "type": "NDC"
    },
    {
      "code": "73177014632_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    },
    {
      "minimum": 1.0,
      "maximum": 23.5,
      "gross_charge": 25.0,
      "discounted_cash": 13.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.95,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.5,
          "standard_charge_percentage": 94.0,
          "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": 9.16,
          "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": 7.3275,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 21.2,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 20.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.25,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.25,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.25,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.25,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.5,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.5,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.5,
          "standard_charge_percentage": 94.0,
          "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": 11.875,
          "standard_charge_percentage": 47.5,
          "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": 6.25,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    },
    {
      "minimum": 1.0,
      "maximum": 35.25,
      "gross_charge": 37.5,
      "discounted_cash": 20.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 25.425,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.475,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.25,
          "standard_charge_percentage": 94.0,
          "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": 13.74,
          "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": 10.99125,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 30.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.475,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 31.8,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.875,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.375,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.375,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.5625,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.5625,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.375,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.75,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.75,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.475,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.25,
          "standard_charge_percentage": 94.0,
          "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": 17.8125,
          "standard_charge_percentage": 47.5,
          "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": 9.375,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE 2 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68084094925",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.48,
      "maximum": 9.32,
      "gross_charge": 9.91,
      "discounted_cash": 5.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.71898,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.41086,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.3154,
          "standard_charge_percentage": 94.0,
          "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": 3.631024,
          "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": 2.904621,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7.928,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.41086,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 8.40368,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.4235,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.8199,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.8199,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.86945,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.86945,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.6487,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.919,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.919,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.41086,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.3154,
          "standard_charge_percentage": 94.0,
          "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": 4.70725,
          "standard_charge_percentage": 47.5,
          "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": 2.4775,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE 2.5 MG/0.5ML IN NEBU",
  "drug_information": {
    "unit": 0.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00487990130_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE 5 MG/ML CONTINUOUS NEBULIZATION (503B)",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "69374033005_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.25,
      "maximum": 23.5,
      "gross_charge": 25.0,
      "discounted_cash": 13.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.95,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.5,
          "standard_charge_percentage": 94.0,
          "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": 9.16,
          "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": 7.3275,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 21.2,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 20.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.25,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.25,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.25,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.25,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.5,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.5,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.5,
          "standard_charge_percentage": 94.0,
          "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": 11.875,
          "standard_charge_percentage": 47.5,
          "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": 6.25,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE 5 MG/ML CONTINUOUS NEBULIZATION MAINTENANCE",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "69374033005_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.25,
      "maximum": 23.5,
      "gross_charge": 25.0,
      "discounted_cash": 13.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.95,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.5,
          "standard_charge_percentage": 94.0,
          "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": 7.3275,
          "standard_charge_percentage": 29.31,
          "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": 9.16,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 20.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 21.2,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.25,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.25,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.25,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.375,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.25,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.5,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.5,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.65,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.5,
          "standard_charge_percentage": 94.0,
          "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": 11.875,
          "standard_charge_percentage": 47.5,
          "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": 6.25,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE HFA 108 (90 BASE) 8 GM INHALER (OR BULK CHARGE)",
  "drug_information": {
    "unit": 8.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "00173068224",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.73,
      "maximum": 47.87,
      "gross_charge": 50.93,
      "discounted_cash": 28.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.53054,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.80778,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.8742,
          "standard_charge_percentage": 94.0,
          "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": 18.660752,
          "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": 14.927583,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.80778,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 43.18864,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 40.744,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.2905,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.3277,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.3277,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.58235,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.58235,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.0301,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.837,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.837,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.80778,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47.8742,
          "standard_charge_percentage": 94.0,
          "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": 24.19175,
          "standard_charge_percentage": 47.5,
          "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": 12.7325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS",
  "drug_information": {
    "unit": 8.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "00173068224_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.73,
      "maximum": 47.87,
      "gross_charge": 50.93,
      "discounted_cash": 28.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.53054,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.80778,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.8742,
          "standard_charge_percentage": 94.0,
          "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": 18.660752,
          "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": 14.927583,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.80778,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 43.18864,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 40.744,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.2905,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.3277,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.3277,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.58235,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.58235,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.0301,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.837,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.837,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.80778,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47.8742,
          "standard_charge_percentage": 94.0,
          "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": 24.19175,
          "standard_charge_percentage": 47.5,
          "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": 12.7325,
          "standard_charge_percentage": 25.0,
          "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": 16.13,
      "maximum": 29.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.051579,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "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": 99.01,
      "maximum": 181.34,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 99.01164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 99.01164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 118.429857,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 181.34,
          "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": 181.34,
          "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": 20.9,
      "maximum": 38.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.958209,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALDESLEUKIN 22000000 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "73776002201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1823.02,
      "maximum": 15655.15,
      "gross_charge": 16654.41,
      "discounted_cash": 9159.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11291.68998,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1823.02302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15655.1454,
          "standard_charge_percentage": 94.0,
          "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": 4881.407571,
          "standard_charge_percentage": 29.31,
          "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": 6102.175824,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1823.02302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6181.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "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": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14156.2485,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14822.4249,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14822.4249,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14905.69695,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14905.69695,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9493.0137,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14988.969,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14988.969,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3907.558746,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15655.1454,
          "standard_charge_percentage": 94.0,
          "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": 7910.84475,
          "standard_charge_percentage": 47.5,
          "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": 3338.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALDOSTERONE SUPPRESSION EVAL",
  "code_information": [
    {
      "code": "80408",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 68.52,
      "maximum": 125.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.523,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.523,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 92.50605,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ALENDRONATE SODIUM 10 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "1671463101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALENDRONATE SODIUM 35 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "69097022316",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALENDRONATE SODIUM 70 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "64980034214",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alexiguard dl-t per sq cm",
  "code_information": [
    {
      "code": "Q4417",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALFUZOSIN HCL ER 10 MG PO TB24",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "57237011490",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALGLUCOSIDASE ALFA 50 MG IV SOLR (LUMIZYME)",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58468016001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 113.23,
      "maximum": 3626.26,
      "gross_charge": 3857.72,
      "discounted_cash": 2121.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2615.53416,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 113.22948,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3626.2568,
          "standard_charge_percentage": 94.0,
          "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": 1413.468608,
          "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": 1130.697732,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 202.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 202.6485,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 113.22948,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3279.062,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3433.3708,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3433.3708,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3452.6594,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3452.6594,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2198.9004,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3471.948,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3471.948,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 148.872087,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 207.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3626.2568,
          "standard_charge_percentage": 94.0,
          "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": 1832.417,
          "standard_charge_percentage": 47.5,
          "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": 207.38,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alglucosidase alfa injection",
  "code_information": [
    {
      "code": "J0220",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 198.9,
      "maximum": 198.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "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",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 198.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ALIROCUMAB 75 MG/ML SC SOAJ",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "61755002002",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.69,
      "maximum": 754.59,
      "gross_charge": 802.76,
      "discounted_cash": 441.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 544.27128,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 438.30696,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 754.5944,
          "standard_charge_percentage": 94.0,
          "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": 294.131264,
          "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": 235.288956,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 680.74048,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 642.208,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 438.30696,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 682.346,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 714.4564,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 714.4564,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 718.4702,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 718.4702,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 457.5732,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 722.484,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 722.484,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 438.30696,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 754.5944,
          "standard_charge_percentage": 94.0,
          "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": 381.311,
          "standard_charge_percentage": 47.5,
          "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": 200.69,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALISKIREN FUMARATE 150 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "66993014130",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.51,
      "maximum": 9.43,
      "gross_charge": 10.03,
      "discounted_cash": 5.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.80034,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.47638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.4282,
          "standard_charge_percentage": 94.0,
          "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": 3.674992,
          "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": 2.939793,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 8.024,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 8.50544,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.47638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.5255,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.9267,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.9267,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.97685,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.97685,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.7171,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.027,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.027,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.47638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.4282,
          "standard_charge_percentage": 94.0,
          "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": 4.76425,
          "standard_charge_percentage": 47.5,
          "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": 2.5075,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALISKIREN FUMARATE 300 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "49884042511",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.96,
      "maximum": 14.88,
      "gross_charge": 15.83,
      "discounted_cash": 8.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.73274,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.64318,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.8802,
          "standard_charge_percentage": 94.0,
          "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": 5.800112,
          "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": 4.639773,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.64318,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 13.42384,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 12.664,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.4555,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.0887,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.0887,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.16785,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.16785,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.0231,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.247,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.247,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.64318,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.8802,
          "standard_charge_percentage": 94.0,
          "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": 7.51925,
          "standard_charge_percentage": 47.5,
          "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": 3.9575,
          "standard_charge_percentage": 25.0,
          "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": 20.84,
      "maximum": 38.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.931175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.16,
          "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": 38.16,
          "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": 16.13,
      "maximum": 29.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.051579,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALLERGEN SPECIFIC IGG",
  "code_information": [
    {
      "code": "86001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.27,
      "maximum": 7.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.26972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.26972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.764122,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ALLG SPEC IGE CRUDE XTRC EA",
  "code_information": [
    {
      "code": "86003",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.85,
      "maximum": 5.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.85012,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.85012,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.847662,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 4.35,
      "maximum": 7.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.35162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.35162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.874687,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 9.79,
      "maximum": 17.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.78978,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.78978,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.216203,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alloderm",
  "code_information": [
    {
      "code": "Q4116",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alloply, per sq cm",
  "code_information": [
    {
      "code": "Q4323",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALLOPURINOL 0.2 MG/ML SUSPENSION",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P0378013710",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALLOPURINOL 100 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687067701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALLOPURINOL 20 MG/ML ORAL SUSPENSION",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P0378013701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALLOPURINOL 300 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687068801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALLOPURINOL 50 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "0378013701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALLOPURINOL SODIUM 500 MG IV SOLR",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "67457018750",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.4,
      "maximum": 3167.06,
      "gross_charge": 3369.21,
      "discounted_cash": 1853.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2284.32438,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.4024,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3167.0574,
          "standard_charge_percentage": 94.0,
          "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": 1234.478544,
          "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": 987.515451,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.936,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.4024,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2863.8285,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2998.5969,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2998.5969,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3015.44295,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3015.44295,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1920.4497,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3032.289,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3032.289,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.6855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3167.0574,
          "standard_charge_percentage": 94.0,
          "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": 1600.37475,
          "standard_charge_percentage": 47.5,
          "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": 4.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alloskin",
  "code_information": [
    {
      "code": "Q4115",
      "type": "HCPCS"
    },
    {
      "code": "Q4123",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alloskin ac, 1 cm",
  "code_information": [
    {
      "code": "Q4141",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Allowrap ds or dry 1 sq cm",
  "code_information": [
    {
      "code": "Q4150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALPHA-1-ANTITRYPSIN PHENO",
  "code_information": [
    {
      "code": "82104",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.9,
      "maximum": 14.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.89516,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.89516,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.658466,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 7.34,
      "maximum": 13.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.33824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.33824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.906624,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 9.28,
      "maximum": 17.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.282,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.282,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.5307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 35.17,
      "maximum": 64.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.16786,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.16786,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.476611,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 9.16,
      "maximum": 16.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.15642,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.15642,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.361167,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ALPHA-LIPOIC ACID 600 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "47469004472",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPHA1-PROTEINASE INHIBITOR 1000 MG/20ML IV SOLN",
  "drug_information": {
    "unit": 1.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "13533070501_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.93,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.93202,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.93202,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.12,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.04,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.641274,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 5.37,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPHA1-PROTEINASE INHIBITOR 1000 MG/20ML IV SOLN|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "13533070501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.37,
      "maximum": 5.37,
      "gross_charge": 1.25,
      "discounted_cash": 0.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.8475,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.93202,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.175,
          "standard_charge_percentage": 94.0,
          "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": 0.366375,
          "standard_charge_percentage": 29.31,
          "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": 0.458,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 0.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.93202,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.0625,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.1125,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.1125,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.11875,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.11875,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.7125,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.125,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.125,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.641274,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.175,
          "standard_charge_percentage": 94.0,
          "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": 0.59375,
          "standard_charge_percentage": 47.5,
          "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": 5.37,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN",
  "drug_information": {
    "unit": 1.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00944288401_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00944288401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.4,
      "maximum": 1.5,
      "gross_charge": 1.6,
      "discounted_cash": 0.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.0848,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.8736,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.504,
          "standard_charge_percentage": 94.0,
          "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": 0.46896,
          "standard_charge_percentage": 29.31,
          "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": 0.58624,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 1.28,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 1.3568,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.8736,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.36,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.424,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.424,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.432,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.432,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.912,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.44,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.44,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.8736,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.504,
          "standard_charge_percentage": 94.0,
          "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": 0.76,
          "standard_charge_percentage": 47.5,
          "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": 0.4,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPRAZOLAM 0.25 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687037701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.9312,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPRAZOLAM 0.5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687038801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.9312,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPRAZOLAM 1 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R5976237211",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "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": 2.9312,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPRAZOLAM 2 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781108901",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "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": 2.9312,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPRAZOLAM ER 0.5 MG PO TB24",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00228308306",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.9312,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPROSTADIL (VASODILATOR) 20 MCG IC SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00009370105",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 71.34,
      "maximum": 268.22,
      "gross_charge": 285.34,
      "discounted_cash": 156.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 193.46052,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 155.79564,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 268.2196,
          "standard_charge_percentage": 94.0,
          "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": 104.548576,
          "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": 83.633154,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 228.272,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 155.79564,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 241.96832,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 242.539,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.9526,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.9526,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 255.3793,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 261.94212,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 162.6438,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.806,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.806,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 155.79564,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 268.2196,
          "standard_charge_percentage": 94.0,
          "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": 135.5365,
          "standard_charge_percentage": 47.5,
          "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": 71.335,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALPROSTADIL 500 MCG/ML IJ SOLN",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00009316906",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 102.7,
      "maximum": 386.15,
      "gross_charge": 410.8,
      "discounted_cash": 225.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 278.5224,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 224.2968,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 386.152,
          "standard_charge_percentage": 94.0,
          "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": 150.51712,
          "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": 120.40548,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 348.3584,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 224.2968,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 328.64,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 349.18,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 365.612,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 365.612,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 367.666,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 377.1144,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 234.156,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 369.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 369.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 224.2968,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 386.152,
          "standard_charge_percentage": 94.0,
          "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": 195.13,
          "standard_charge_percentage": 47.5,
          "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": 102.7,
          "standard_charge_percentage": 25.0,
          "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": 74.75,
      "maximum": 74.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.749,
          "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": 74.98,
      "maximum": 137.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.97672,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.97672,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.32,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALTEPLASE 100 MG IV SOLR",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242008527",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6402.26,
      "maximum": 24072.51,
      "gross_charge": 25609.05,
      "discounted_cash": 14084.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 17362.9359,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13982.5413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24072.507,
          "standard_charge_percentage": 94.0,
          "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": 9383.15592,
          "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": 7506.012555,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 16897.0,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 15948.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13982.5413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21767.6925,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22792.0545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22792.0545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22920.09975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22920.09975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14597.1585,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23048.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23048.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13982.5413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24072.507,
          "standard_charge_percentage": 94.0,
          "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": 12164.29875,
          "standard_charge_percentage": 47.5,
          "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": 6402.2625,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALTEPLASE 100 MG IV SOLR (PE)",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242008527_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6419.76,
      "maximum": 24138.31,
      "gross_charge": 25679.05,
      "discounted_cash": 14123.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 17410.3959,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14020.7613,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24138.307,
          "standard_charge_percentage": 94.0,
          "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": 9408.80392,
          "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": 7526.529555,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 15948.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 16897.0,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14020.7613,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21827.1925,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22854.3545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22854.3545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22982.74975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22982.74975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14637.0585,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23111.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23111.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14020.7613,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24138.307,
          "standard_charge_percentage": 94.0,
          "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": 12197.54875,
          "standard_charge_percentage": 47.5,
          "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": 6419.7625,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALTEPLASE 100 MG IV SOLR (PE)|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242008527_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6402.26,
      "maximum": 24072.51,
      "gross_charge": 25609.05,
      "discounted_cash": 14084.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 17362.9359,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13982.5413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24072.507,
          "standard_charge_percentage": 94.0,
          "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": 9383.15592,
          "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": 7506.012555,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 16897.0,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 15948.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13982.5413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21767.6925,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22792.0545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22792.0545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22920.09975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22920.09975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14597.1585,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23048.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23048.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13982.5413,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24072.507,
          "standard_charge_percentage": 94.0,
          "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": 12164.29875,
          "standard_charge_percentage": 47.5,
          "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": 6402.2625,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALTEPLASE 2 MG IJ SOLR",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242004164",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 51.23,
      "maximum": 562.79,
      "gross_charge": 598.71,
      "discounted_cash": 329.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 405.92538,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 219.367344,
          "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": 175.481901,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.0975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 508.9035,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 341.2647,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.422537,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 284.38725,
          "standard_charge_percentage": 47.5,
          "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": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALTEPLASE 2 MG IJ SOLR (APHERESIS)",
  "drug_information": {
    "unit": 0.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242004164_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 51.23,
      "maximum": 562.79,
      "gross_charge": 598.71,
      "discounted_cash": 329.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 405.92538,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 219.367344,
          "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": 175.481901,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 508.9035,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 341.2647,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.422537,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 284.38725,
          "standard_charge_percentage": 47.5,
          "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": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALTEPLASE 2 MG IJ SOLR FOR 0.5 MG DOSE FOR IV LINE DECLOTTING",
  "drug_information": {
    "unit": 0.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242004164_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 51.23,
      "maximum": 562.79,
      "gross_charge": 598.71,
      "discounted_cash": 329.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 405.92538,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 219.367344,
          "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": 175.481901,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.0975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 508.9035,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 341.2647,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.422537,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 284.38725,
          "standard_charge_percentage": 47.5,
          "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": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALTEPLASE 2 MG IJ SOLR FOR 1 MG DOSE FOR IV LINE DECLOTTING",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242004164_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 51.23,
      "maximum": 562.79,
      "gross_charge": 598.71,
      "discounted_cash": 329.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 405.92538,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 219.367344,
          "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": 175.481901,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.0975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 508.9035,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 341.2647,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.422537,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 284.38725,
          "standard_charge_percentage": 47.5,
          "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": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALTEPLASE 2 MG IJ SOLR FOR 2 MG DOSE FOR IV LINE DECLOTTING",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242004164_5",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 51.23,
      "maximum": 562.79,
      "gross_charge": 598.71,
      "discounted_cash": 329.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 405.92538,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 219.367344,
          "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": 175.481901,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.23118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 508.9035,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.8519,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 535.84545,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 341.2647,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 538.839,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.422537,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 562.7874,
          "standard_charge_percentage": 94.0,
          "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": 284.38725,
          "standard_charge_percentage": 47.5,
          "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": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALTEPLASE 50 MG IV SOLR",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242004413",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3201.14,
      "maximum": 12036.27,
      "gross_charge": 12804.54,
      "discounted_cash": 7042.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8681.47812,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6991.27884,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12036.2676,
          "standard_charge_percentage": 94.0,
          "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": 3753.010674,
          "standard_charge_percentage": 29.31,
          "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": 4691.583456,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 10858.24992,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6991.27884,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 10243.632,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10883.859,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11396.0406,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11396.0406,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11460.0633,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11460.0633,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7298.5878,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11524.086,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11524.086,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6991.27884,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12036.2676,
          "standard_charge_percentage": 94.0,
          "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": 6082.1565,
          "standard_charge_percentage": 47.5,
          "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": 3201.135,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Altuviiio per factor viii iu",
  "code_information": [
    {
      "code": "J7214",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.51,
      "maximum": 5.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.5116,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.5116,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.58,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.456999,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALUM & MAG HYDROXIDE-SIMETH 400-400-40 MG/5ML PO SUSP",
  "drug_information": {
    "unit": 30.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00121176230",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.84,
      "maximum": 6.93,
      "gross_charge": 7.37,
      "discounted_cash": 4.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.99686,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.02402,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.9278,
          "standard_charge_percentage": 94.0,
          "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": 2.700368,
          "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": 2.160147,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.24976,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.02402,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5.896,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.2645,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.5593,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.5593,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.59615,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.59615,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.2009,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.633,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.633,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.02402,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.9278,
          "standard_charge_percentage": 94.0,
          "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": 3.50075,
          "standard_charge_percentage": 47.5,
          "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": 1.8425,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALUM HYDROXIDE-MAG CARBONATE 95-358 MG/15ML PO SUSP",
  "drug_information": {
    "unit": 355.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00904772714",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.88,
      "maximum": 7.08,
      "gross_charge": 7.53,
      "discounted_cash": 4.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.10534,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.11138,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.0782,
          "standard_charge_percentage": 94.0,
          "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": 2.758992,
          "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": 2.207043,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.024,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.11138,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.38544,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.4005,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.7017,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.7017,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.73935,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.73935,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.2921,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.777,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.777,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.11138,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.0782,
          "standard_charge_percentage": 94.0,
          "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": 3.57675,
          "standard_charge_percentage": 47.5,
          "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": 1.8825,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALUM POTASSIUM SULFATE 10% IRRIGATION SOLN",
  "drug_information": {
    "unit": 300.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "05446063730",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 62.5,
      "maximum": 235.0,
      "gross_charge": 250.0,
      "discounted_cash": 137.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 169.5,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.5,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 235.0,
          "standard_charge_percentage": 94.0,
          "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": 73.275,
          "standard_charge_percentage": 29.31,
          "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": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.5,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 212.0,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 200.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 212.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 222.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 222.5,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.75,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 229.5,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 142.5,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.5,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 235.0,
          "standard_charge_percentage": 94.0,
          "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": 118.75,
          "standard_charge_percentage": 47.5,
          "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": 62.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALUMINUM CHLORIDE 20 % EX SOLN",
  "drug_information": {
    "unit": 35.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00096070735",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.81,
      "maximum": 18.1,
      "gross_charge": 19.25,
      "discounted_cash": 10.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.0515,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.5105,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 18.095,
          "standard_charge_percentage": 94.0,
          "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": 7.0532,
          "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": 5.642175,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.5105,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 16.324,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 15.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.3625,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.1325,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.1325,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.22875,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.22875,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.9725,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.325,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.325,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.5105,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.095,
          "standard_charge_percentage": 94.0,
          "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": 9.14375,
          "standard_charge_percentage": 47.5,
          "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": 4.8125,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP",
  "drug_information": {
    "unit": 473.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00536009185",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.52,
      "maximum": 9.48,
      "gross_charge": 10.08,
      "discounted_cash": 5.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.83424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.50368,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.4752,
          "standard_charge_percentage": 94.0,
          "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": 3.693312,
          "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": 2.954448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 8.54784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 8.064,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.50368,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.568,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.9712,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.9712,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.0216,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.0216,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.7456,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.072,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.072,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.50368,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.4752,
          "standard_charge_percentage": 94.0,
          "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": 4.788,
          "standard_charge_percentage": 47.5,
          "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": 2.52,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALVEOLOPLASTY EACH QUADRANT",
  "code_information": [
    {
      "code": "41874",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1849.45,
      "maximum": 3387.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1849.44942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1849.44942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2390.466897,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3387.27,
          "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": 3387.27,
          "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": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "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": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "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": 1849.45,
      "maximum": 3387.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1849.44942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1849.44942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2390.466897,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3387.27,
          "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": 3387.27,
          "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": 3302.24,
      "maximum": 6048.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4360.432986,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6048.05,
          "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": 6048.05,
          "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": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "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": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "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": 53.03,
      "maximum": 97.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.03298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.03298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.658409,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.13,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALYS CPLX CN NPGT PRGRMG",
  "code_information": [
    {
      "code": "95977",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 53.03,
      "maximum": 97.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.03298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.03298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.658409,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.13,
          "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": 53.03,
      "maximum": 97.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.03298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.03298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.658409,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.13,
          "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": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "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": 20.82,
      "maximum": 38.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.81898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.81898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.486459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.13,
          "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": 53.03,
      "maximum": 97.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.03298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.03298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.658409,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.13,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "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": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "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": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "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": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMANTADINE HCL 100 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687042201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMANTADINE HCL 50 MG/5ML PO SOLN",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00121064610",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.75,
      "maximum": 6.58,
      "gross_charge": 7.0,
      "discounted_cash": 3.85,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.746,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.822,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.58,
          "standard_charge_percentage": 94.0,
          "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": 2.5648,
          "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": 2.0517,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5.6,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.822,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 5.936,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.95,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.23,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.23,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.265,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.265,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.99,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.3,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.3,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.822,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.58,
          "standard_charge_percentage": 94.0,
          "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": 3.325,
          "standard_charge_percentage": 47.5,
          "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": 1.75,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMBL BP MNTR W/SW A/R",
  "code_information": [
    {
      "code": "93788",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMBL BP MNTR W/SW REC ONLY",
  "code_information": [
    {
      "code": "93786",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMBRISENTAN 10 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00591240630",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 62.65,
      "maximum": 235.55,
      "gross_charge": 250.59,
      "discounted_cash": 137.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 169.90002,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.82214,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 235.5546,
          "standard_charge_percentage": 94.0,
          "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": 73.447929,
          "standard_charge_percentage": 29.31,
          "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": 91.816176,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.82214,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 200.472,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 212.50032,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 213.0015,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.0251,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.0251,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 224.27805,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 224.27805,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 142.8363,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.531,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.531,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.82214,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 235.5546,
          "standard_charge_percentage": 94.0,
          "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": 119.03025,
          "standard_charge_percentage": 47.5,
          "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": 62.6475,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMBRISENTAN 5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00378427093",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.6,
      "maximum": 36.09,
      "gross_charge": 38.39,
      "discounted_cash": 21.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.02842,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.96094,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.0866,
          "standard_charge_percentage": 94.0,
          "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": 14.066096,
          "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": 11.252109,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 30.712,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 32.55472,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.96094,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.6315,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.1671,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.1671,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.35905,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.35905,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.8823,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.551,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.551,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.96094,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0866,
          "standard_charge_percentage": 94.0,
          "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": 18.23525,
          "standard_charge_percentage": 47.5,
          "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": 9.5975,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amchomatrixdl per sq cm",
  "code_information": [
    {
      "code": "Q4410",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amifostine",
  "code_information": [
    {
      "code": "J0207",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1092.84,
      "maximum": 1092.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1092.84,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1092.8365,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AMIKACIN INTRAVITREAL INJ (0.2MG/0.1ML)",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252003300",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIKACIN INTRAVITREAL INJ (0.4MG/0.1ML)",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252003400",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIKACIN INTRAVITREAL INJ (0.6MG/0.1ML)",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252000300",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIKACIN OPHTHALMIC SOLN 25 MG/ML",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252001900",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIKACIN SULFATE 1 G/4 ML IJ SOLN FOR INHALATION",
  "drug_information": {
    "unit": 4.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "23155029042_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIKACIN SULFATE 1 GM/4ML IJ SOLN",
  "drug_information": {
    "unit": 4.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "23155029042",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.53,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.58,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIKACIN SULFATE 500 MG/2ML IJ SOLN",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00641616710",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.53,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.58,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMILORIDE HCL 5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R0574029201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "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": 3.27,
      "maximum": 5.99,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.27054,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.27054,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.415229,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 5 % IV SOLN",
  "drug_information": {
    "unit": 1000.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "71266802001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 201.88,
      "maximum": 759.05,
      "gross_charge": 807.5,
      "discounted_cash": 444.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 547.485,
          "standard_charge_percentage": 67.8,
          "median_amount": 27.2,
          "10th_percentile": 27.12,
          "90th_percentile": 44.4,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 440.895,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 759.05,
          "standard_charge_percentage": 94.0,
          "median_amount": 6.8,
          "10th_percentile": 6.8,
          "90th_percentile": 45.0,
          "count": "62",
          "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": 236.67825,
          "standard_charge_percentage": 29.31,
          "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": 295.868,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 684.76,
          "standard_charge_percentage": 84.8,
          "median_amount": 31.8,
          "10th_percentile": 6.74,
          "90th_percentile": 43.73,
          "count": "11",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 440.895,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 646.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 686.375,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 718.675,
          "standard_charge_percentage": 89.0,
          "median_amount": 24.69,
          "10th_percentile": 21.95,
          "90th_percentile": 28.36,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 718.675,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 722.7125,
          "standard_charge_percentage": 89.5,
          "median_amount": 28.54,
          "10th_percentile": 28.54,
          "90th_percentile": 32.25,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 722.7125,
          "standard_charge_percentage": 89.5,
          "median_amount": 28.54,
          "10th_percentile": 28.54,
          "90th_percentile": 32.25,
          "count": "11",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 460.275,
          "standard_charge_percentage": 57.0,
          "median_amount": 23.96,
          "10th_percentile": 22.8,
          "90th_percentile": 26.96,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 726.75,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 726.75,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 440.895,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 759.05,
          "standard_charge_percentage": 94.0,
          "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": 383.5625,
          "standard_charge_percentage": 47.5,
          "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": 201.875,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "Estimated Allowed derived from 12 months prior to as of date of historical Payer/Plan specific claim"
    }
  ]
},
{
  "description": "AMINO ACID INFUSION IN D10W 3 % IV SOLN (503B)",
  "drug_information": {
    "unit": 250.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "72196040401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.14,
      "maximum": 41.88,
      "gross_charge": 44.55,
      "discounted_cash": 24.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.2049,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.3243,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 41.877,
          "standard_charge_percentage": 94.0,
          "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": 16.32312,
          "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": 13.057605,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 35.64,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.3243,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 37.7784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.8675,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.6495,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.6495,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.8969,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.87225,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 25.3935,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.095,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.095,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.3243,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.877,
          "standard_charge_percentage": 94.0,
          "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": 21.16125,
          "standard_charge_percentage": 47.5,
          "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": 11.1375,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINO ACID INFUSION IN D10W 3 % W/ CALCIUM GLUC 2.33 MEQ HEPARIN 125 UNITS IV SOLN (503B)",
  "drug_information": {
    "unit": 250.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "72196042801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.43,
      "maximum": 46.72,
      "gross_charge": 49.7,
      "discounted_cash": 27.34,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.6966,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.1362,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 46.718,
          "standard_charge_percentage": 94.0,
          "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": 14.56707,
          "standard_charge_percentage": 29.31,
          "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": 18.21008,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 39.76,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.1362,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 42.1456,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.245,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.233,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.233,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.4815,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.6246,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.329,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.73,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.73,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.1362,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.718,
          "standard_charge_percentage": 94.0,
          "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": 23.6075,
          "standard_charge_percentage": 47.5,
          "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": 12.425,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINO ACID INFUSION IN D10W 4.25 % IV SOLN",
  "drug_information": {
    "unit": 1000.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00338113403",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.67,
      "maximum": 28.85,
      "gross_charge": 30.69,
      "discounted_cash": 16.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20.80782,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.75674,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.8486,
          "standard_charge_percentage": 94.0,
          "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": 8.995239,
          "standard_charge_percentage": 29.31,
          "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": 11.244816,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 26.02512,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.75674,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 24.552,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.0865,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.3141,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.3141,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.17342,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.46755,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 17.4933,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.621,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.621,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.75674,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.8486,
          "standard_charge_percentage": 94.0,
          "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": 14.57775,
          "standard_charge_percentage": 47.5,
          "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": 7.6725,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINO ACID SINGLE QUAL",
  "code_information": [
    {
      "code": "82127",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.74,
      "maximum": 14.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.74228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.74228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.452078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 7.57,
      "maximum": 13.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.57302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.57302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.223577,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 9.21,
      "maximum": 16.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.434877,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 10.71,
      "maximum": 19.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.70706,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.70706,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.454531,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 12.55,
      "maximum": 22.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.54708,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.54708,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.938558,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 0.25 GM/ML PO SOLN",
  "drug_information": {
    "unit": 237.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "52817081508",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 402.76,
      "maximum": 1514.36,
      "gross_charge": 1611.02,
      "discounted_cash": 886.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1092.27156,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 879.61692,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1514.3588,
          "standard_charge_percentage": 94.0,
          "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": 590.277728,
          "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": 472.189962,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 879.61692,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 1288.816,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 1366.14496,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1369.367,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1433.8078,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1433.8078,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1441.8629,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1441.8629,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 918.2814,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1449.918,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1449.918,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 879.61692,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1514.3588,
          "standard_charge_percentage": 94.0,
          "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": 765.2345,
          "standard_charge_percentage": 47.5,
          "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": 402.755,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINOCAPROIC ACID 250 MG/ML IV SOLN",
  "drug_information": {
    "unit": 20.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00517912025",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINOCAPROIC ACID 500 MG PO TABS",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687073925",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17.91,
      "maximum": 67.32,
      "gross_charge": 71.62,
      "discounted_cash": 39.39,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 48.55836,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.10452,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.3228,
          "standard_charge_percentage": 94.0,
          "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": 26.241568,
          "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": 20.991822,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.10452,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 60.73376,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 57.296,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 60.877,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.7418,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.7418,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.0999,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.0999,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 40.8234,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.458,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.458,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.10452,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 67.3228,
          "standard_charge_percentage": 94.0,
          "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": 34.0195,
          "standard_charge_percentage": 47.5,
          "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": 17.905,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINOLEVULINIC ACID HCL 1.5 G PO SOLR",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "59137023101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3196.0,
      "maximum": 12016.96,
      "gross_charge": 12784.0,
      "discounted_cash": 7031.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8667.552,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6980.064,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12016.96,
          "standard_charge_percentage": 94.0,
          "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": 4684.0576,
          "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": 3746.9904,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6980.064,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 10840.832,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 10227.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10866.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11377.76,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11377.76,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11441.68,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11441.68,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7286.88,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11505.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11505.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6980.064,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12016.96,
          "standard_charge_percentage": 94.0,
          "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": 6072.4,
          "standard_charge_percentage": 47.5,
          "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": 3196.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINOLEVULINIC ACID HCL 20 % EX SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "67308010106",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 212.84,
      "maximum": 1317.73,
      "gross_charge": 1401.84,
      "discounted_cash": 771.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 950.44752,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 212.84172,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1317.7296,
          "standard_charge_percentage": 94.0,
          "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": 513.634176,
          "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": 410.879304,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 212.84172,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 401.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1191.564,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1247.6376,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1247.6376,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1254.6468,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1254.6468,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 799.0488,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1261.656,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1261.656,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 292.606587,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1317.7296,
          "standard_charge_percentage": 94.0,
          "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": 665.874,
          "standard_charge_percentage": 47.5,
          "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": 389.82,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aminolevulinic acid, 10% gel",
  "code_information": [
    {
      "code": "J7345",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.97,
      "maximum": 1.85,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.97188,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.97188,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.267812,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMINOPHYLLINE 2 MG/ML SOLUTION",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P0409592101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINOPHYLLINE 25 MG/ML IV SOLN",
  "drug_information": {
    "unit": 20.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00409592201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE 10MG/ML SUSPENSION",
  "drug_information": {
    "unit": 20.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252000155",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 100 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00245014401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 150 MG/100 ML DRIP RTU",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "43066015010",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.92,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.9185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 150 MG/3 ML IV SOLN 3 ML VIAL (BULK CHARGE)",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00143987525",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.48,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 150 MG/3ML IV SOLN",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00143987525_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.48,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 150 MG/3ML IV SOLN -CODE USE PEDS",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00143987525_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.48,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 200 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687043701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 360 MG/200 ML DRIP RTU",
  "drug_information": {
    "unit": 200.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "43066036020",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.92,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.9185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 450 MG/9ML IV SOLN",
  "drug_information": {
    "unit": 9.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "63323061609",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.48,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIODARONE HCL 900 MG/18ML IV SOLN",
  "drug_information": {
    "unit": 18.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "67457015318",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.48,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMITRIPTYLINE HCL 10 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50268003715",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMITRIPTYLINE HCL 100 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R1672917501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMITRIPTYLINE HCL 25 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687043301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMITRIPTYLINE HCL 50 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687044401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMITRIPTYLINE HCL 75 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "1657110801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMIVANTAMAB-VMJW 350 MG/7ML IV SOLN",
  "drug_information": {
    "unit": 7.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "57894050101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2734.76,
      "maximum": 10282.71,
      "gross_charge": 10939.05,
      "discounted_cash": 6016.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7416.6759,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5972.7213,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10282.707,
          "standard_charge_percentage": 94.0,
          "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": 4008.06792,
          "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": 3206.235555,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 8751.24,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5972.7213,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 9276.3144,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9298.1925,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9735.7545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9735.7545,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9790.44975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9790.44975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6235.2585,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9845.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9845.145,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5972.7213,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10282.707,
          "standard_charge_percentage": 94.0,
          "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": 5196.04875,
          "standard_charge_percentage": 47.5,
          "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": 2734.7625,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMLODIPINE BENZOATE 1 MG/ML PO SUSP",
  "drug_information": {
    "unit": 150.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "52652500101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 332.23,
      "maximum": 1249.17,
      "gross_charge": 1328.9,
      "discounted_cash": 730.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 900.9942,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 725.5794,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1249.166,
          "standard_charge_percentage": 94.0,
          "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": 389.50059,
          "standard_charge_percentage": 29.31,
          "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": 486.90896,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 725.5794,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 1063.12,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 1126.9072,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1129.565,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1182.721,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1182.721,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1189.3655,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1189.3655,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 757.473,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1196.01,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1196.01,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 725.5794,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1249.166,
          "standard_charge_percentage": 94.0,
          "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": 631.2275,
          "standard_charge_percentage": 47.5,
          "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": 332.225,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMLODIPINE BESY-BENAZEPRIL HCL 10-40 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00078037905",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.21,
      "maximum": 34.64,
      "gross_charge": 36.85,
      "discounted_cash": 20.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.9843,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.1201,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.639,
          "standard_charge_percentage": 94.0,
          "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": 13.50184,
          "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": 10.800735,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.1201,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 29.48,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 31.2488,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.3225,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.7965,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.7965,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.98075,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.98075,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.0045,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.165,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.165,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.1201,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.639,
          "standard_charge_percentage": 94.0,
          "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": 17.50375,
          "standard_charge_percentage": 47.5,
          "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": 9.2125,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMLODIPINE BESY-BENAZEPRIL HCL 5-10 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00078040505",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.82,
      "maximum": 25.62,
      "gross_charge": 27.26,
      "discounted_cash": 14.99,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 18.48228,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.88396,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 25.6244,
          "standard_charge_percentage": 94.0,
          "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": 9.988064,
          "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": 7.989906,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 21.808,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.88396,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 23.11648,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.171,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.2614,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.2614,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.3977,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.3977,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.5382,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.534,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.534,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.88396,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.6244,
          "standard_charge_percentage": 94.0,
          "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": 12.9485,
          "standard_charge_percentage": 47.5,
          "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": 6.815,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMLODIPINE BESYLATE 10 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687049601",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMLODIPINE BESYLATE 2.5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00904636961",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMLODIPINE BESYLATE 5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687048801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMMONIA AROMATIC IN INHA",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252062022",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMMONIUM LACTATE 12 % EX LOTN",
  "drug_information": {
    "unit": 226.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "00904598426",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.2,
      "maximum": 8.25,
      "gross_charge": 8.78,
      "discounted_cash": 4.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.95284,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.79388,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.2532,
          "standard_charge_percentage": 94.0,
          "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": 2.573418,
          "standard_charge_percentage": 29.31,
          "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": 3.216992,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7.44544,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.79388,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7.024,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.463,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.8142,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.8142,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.8581,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.8581,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.0046,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.902,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.902,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.79388,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.2532,
          "standard_charge_percentage": 94.0,
          "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": 4.1705,
          "standard_charge_percentage": 47.5,
          "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": 2.195,
          "standard_charge_percentage": 25.0,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnicore pro, per sq cm",
  "code_information": [
    {
      "code": "Q4298",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnio bur dl mem per sq cm",
  "code_information": [
    {
      "code": "Q4365",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnio quad-core, per sq cm",
  "code_information": [
    {
      "code": "Q4294",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnio tri-core, per sq cm",
  "code_information": [
    {
      "code": "Q4295",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnio wound, per square cm",
  "code_information": [
    {
      "code": "Q4181",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnioamp-mp per sq cm",
  "code_information": [
    {
      "code": "Q4250",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnioarmor 1 sq cm",
  "code_information": [
    {
      "code": "Q4188",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnioband, guardian 1 sq cm",
  "code_information": [
    {
      "code": "Q4151",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMNIOCENTESIS DIAGNOSTIC",
  "code_information": [
    {
      "code": "59000",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 513.79,
      "maximum": 941.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 513.786,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 513.786,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 641.822454,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 941.0,
          "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": 941.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMNIOCENTESIS THERAPEUTIC",
  "code_information": [
    {
      "code": "59001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 169.99,
      "maximum": 311.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 169.98618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 169.98618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 224.218449,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 311.33,
          "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": 311.33,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniocore sl, per sq cm",
  "code_information": [
    {
      "code": "Q4367",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniomatrixf3x per sq cm",
  "code_information": [
    {
      "code": "Q4409",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniotext patch, per sq cm",
  "code_information": [
    {
      "code": "Q4247",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMNIOTIC FLUID SCAN",
  "code_information": [
    {
      "code": "82143",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.11,
      "maximum": 9.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.1051,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.1051,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.891885,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniply, per sq cm",
  "code_information": [
    {
      "code": "Q4249",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amobarbital 125 mg inj",
  "code_information": [
    {
      "code": "J0300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 186.93,
      "maximum": 186.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 186.932,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 186.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AMOXICILLIN 125 MG/5ML PO SUSR",
  "drug_information": {
    "unit": 80.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781603958",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.37,
      "maximum": 5.15,
      "gross_charge": 5.48,
      "discounted_cash": 3.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.71544,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.99208,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.1512,
          "standard_charge_percentage": 94.0,
          "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": 2.007872,
          "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": 1.606188,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.99208,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 4.64704,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 4.384,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.658,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.8772,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.8772,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.9046,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.9046,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.1236,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.932,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.932,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.99208,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.1512,
          "standard_charge_percentage": 94.0,
          "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": 2.603,
          "standard_charge_percentage": 47.5,
          "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": 1.37,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN 250 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R0781202001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN 250 MG PO CHEW",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00093226801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN 250 MG/5ML PO SUSR",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00143988901",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.33,
      "maximum": 4.98,
      "gross_charge": 5.3,
      "discounted_cash": 2.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.5934,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.8938,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.982,
          "standard_charge_percentage": 94.0,
          "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": 1.94192,
          "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": 1.55343,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.8938,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 4.4944,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 4.24,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.505,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.717,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.717,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.7435,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.7435,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.021,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.77,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.77,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.8938,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.982,
          "standard_charge_percentage": 94.0,
          "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": 2.5175,
          "standard_charge_percentage": 47.5,
          "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": 1.325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN 400 MG/5ML PO SUSR",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65862007150",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.56,
      "maximum": 5.86,
      "gross_charge": 6.23,
      "discounted_cash": 3.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.22394,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.40158,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.8562,
          "standard_charge_percentage": 94.0,
          "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": 2.282672,
          "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": 1.826013,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.40158,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 5.28304,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 4.984,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.2955,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.5447,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.5447,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.57585,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.57585,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.5511,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.607,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.607,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.40158,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.8562,
          "standard_charge_percentage": 94.0,
          "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": 2.95925,
          "standard_charge_percentage": 47.5,
          "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": 1.5575,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN 500 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R0781261305",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN 875 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00093226401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN-POT CLAVULANATE 250-125 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687078194",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.88,
      "maximum": 7.07,
      "gross_charge": 7.52,
      "discounted_cash": 4.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.09856,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.10592,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.0688,
          "standard_charge_percentage": 94.0,
          "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": 2.204112,
          "standard_charge_percentage": 29.31,
          "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": 2.755328,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.016,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.10592,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.37696,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.392,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.6928,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.6928,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.7304,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.7304,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.2864,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.768,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.768,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.10592,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.0688,
          "standard_charge_percentage": 94.0,
          "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": 3.572,
          "standard_charge_percentage": 47.5,
          "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": 1.88,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5ML PO SUSR",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60432006500",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.04,
      "maximum": 18.94,
      "gross_charge": 20.15,
      "discounted_cash": 11.08,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.6617,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.0019,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 18.941,
          "standard_charge_percentage": 94.0,
          "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": 5.905965,
          "standard_charge_percentage": 29.31,
          "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": 7.38296,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 16.12,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 17.0872,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.0019,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.1275,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.9335,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.9335,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.03425,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.03425,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.4855,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.135,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.135,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.0019,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.941,
          "standard_charge_percentage": 94.0,
          "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": 9.57125,
          "standard_charge_percentage": 47.5,
          "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": 5.0375,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65862053450",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.1,
      "maximum": 7.88,
      "gross_charge": 8.38,
      "discounted_cash": 4.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.68164,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.57548,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.8772,
          "standard_charge_percentage": 94.0,
          "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": 3.070432,
          "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": 2.456178,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7.10624,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.57548,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.704,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.123,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.4582,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.4582,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.5001,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.5001,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.7766,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.542,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.542,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.57548,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.8772,
          "standard_charge_percentage": 94.0,
          "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": 3.9805,
          "standard_charge_percentage": 47.5,
          "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": 2.095,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687079201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.24,
      "maximum": 4.64,
      "gross_charge": 4.94,
      "discounted_cash": 2.72,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.34932,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.69724,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.6436,
          "standard_charge_percentage": 94.0,
          "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": 1.810016,
          "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": 1.447914,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.69724,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.952,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 4.18912,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.199,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.3966,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.3966,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.4213,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.4213,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.8158,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.446,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.446,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.69724,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.6436,
          "standard_charge_percentage": 94.0,
          "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": 2.3465,
          "standard_charge_percentage": 47.5,
          "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": 1.235,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR",
  "drug_information": {
    "unit": 75.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781613957",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.76,
      "maximum": 14.13,
      "gross_charge": 15.03,
      "discounted_cash": 8.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.19034,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.20638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.1282,
          "standard_charge_percentage": 94.0,
          "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": 5.506992,
          "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": 4.405293,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 12.74544,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.20638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 12.024,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.7755,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.3767,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.3767,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.45185,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.45185,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.5671,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.527,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.527,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.20638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.1282,
          "standard_charge_percentage": 94.0,
          "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": 7.13925,
          "standard_charge_percentage": 47.5,
          "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": 3.7575,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687080301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.27,
      "maximum": 4.78,
      "gross_charge": 5.09,
      "discounted_cash": 2.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.45102,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.77914,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.7846,
          "standard_charge_percentage": 94.0,
          "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": 1.491879,
          "standard_charge_percentage": 29.31,
          "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": 1.864976,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 4.072,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 4.31632,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.77914,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.3265,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.5301,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.5301,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.55555,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.55555,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.9013,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.581,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.581,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.77914,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.7846,
          "standard_charge_percentage": 94.0,
          "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": 2.41775,
          "standard_charge_percentage": 47.5,
          "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": 1.2725,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMOXICILLIN-POT CLAVULANATE ER 1000-62.5 MG PO TB12",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781194382",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.7,
      "maximum": 10.14,
      "gross_charge": 10.79,
      "discounted_cash": 5.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.31562,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.89134,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.1426,
          "standard_charge_percentage": 94.0,
          "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": 3.953456,
          "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": 3.162549,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 8.632,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 9.14992,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.89134,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.1715,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.6031,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.6031,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.65705,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.65705,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.1503,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.711,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.711,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.89134,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.1426,
          "standard_charge_percentage": 94.0,
          "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": 5.12525,
          "standard_charge_percentage": 47.5,
          "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": 2.6975,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHET ER 10 MG PO CP24",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "3172218601",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "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": 2.9312,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHET ER 15 MG PO CP24",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "3172218701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "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": 2.9312,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHET ER 20 MG PO CP24",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "54092038701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.03,
      "maximum": 15.16,
      "gross_charge": 16.13,
      "discounted_cash": 8.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.93614,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.80698,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.1622,
          "standard_charge_percentage": 94.0,
          "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": 5.910032,
          "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": 4.727703,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.80698,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 12.904,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 13.67824,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.7105,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.3557,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.3557,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.43635,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.43635,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.1941,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.517,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.517,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.80698,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.1622,
          "standard_charge_percentage": 94.0,
          "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": 7.66175,
          "standard_charge_percentage": 47.5,
          "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": 4.0325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHET ER 25 MG PO CP24",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "54092038901",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.03,
      "maximum": 15.16,
      "gross_charge": 16.13,
      "discounted_cash": 8.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.93614,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.80698,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.1622,
          "standard_charge_percentage": 94.0,
          "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": 4.727703,
          "standard_charge_percentage": 29.31,
          "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": 5.910032,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 13.67824,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.80698,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 12.904,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.7105,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.3557,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.3557,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.43635,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.43635,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.1941,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.517,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.517,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.80698,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.1622,
          "standard_charge_percentage": 94.0,
          "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": 7.66175,
          "standard_charge_percentage": 47.5,
          "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": 4.0325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHET ER 5 MG PO CP24",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "3172218501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.9312,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "1153419201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "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": 2.9312,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHETAMINE 20 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00527150537",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "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": 2.9312,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHETAMINE 30 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00555097402",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.9312,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R0555097102",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 7.52,
      "gross_charge": 8.0,
      "discounted_cash": 4.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 2.9312,
          "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": 2.3448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 6.4,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6.784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.8,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.12,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.16,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.2,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item 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,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.52,
          "standard_charge_percentage": 94.0,
          "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": 3.8,
          "standard_charge_percentage": 47.5,
          "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": 2.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B 0.167 MG/ML SUSPENSION",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P3982210555",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B 5 MG/ML SUSPENSION",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P3982210557",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.38,
      "maximum": 8.93,
      "gross_charge": 9.5,
      "discounted_cash": 5.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.441,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.187,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.93,
          "standard_charge_percentage": 94.0,
          "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": 2.78445,
          "standard_charge_percentage": 29.31,
          "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": 3.4808,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 8.056,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.187,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7.6,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.075,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.455,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.455,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.5025,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.5025,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.415,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.55,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.55,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.187,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.93,
          "standard_charge_percentage": 94.0,
          "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": 4.5125,
          "standard_charge_percentage": 47.5,
          "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": 2.375,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B 50 MG IV SOLR",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "39822105505",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 21.49,
      "maximum": 80.79,
      "gross_charge": 85.95,
      "discounted_cash": 47.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.2741,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.9287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 80.793,
          "standard_charge_percentage": 94.0,
          "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": 25.191945,
          "standard_charge_percentage": 29.31,
          "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": 31.49208,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "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": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.9287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.0575,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.4955,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.4955,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.92525,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.92525,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 48.9915,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.355,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.355,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.9287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.793,
          "standard_charge_percentage": 94.0,
          "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": 40.82625,
          "standard_charge_percentage": 47.5,
          "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": 21.4875,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B 50 MG IV SOLR (INTRA-ARTICULAR ONLY)",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "39822105505_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 21.49,
      "maximum": 80.79,
      "gross_charge": 85.95,
      "discounted_cash": 47.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.2741,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.9287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 80.793,
          "standard_charge_percentage": 94.0,
          "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": 31.49208,
          "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": 25.191945,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "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": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.9287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.0575,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.4955,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.4955,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.92525,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.92525,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 48.9915,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.355,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.355,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.9287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.793,
          "standard_charge_percentage": 94.0,
          "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": 40.82625,
          "standard_charge_percentage": 47.5,
          "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": 21.4875,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B LIPID 5 MG/ML IV SUSP",
  "drug_information": {
    "unit": 20.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "57665010141",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.2,
      "maximum": 268.18,
      "gross_charge": 285.3,
      "discounted_cash": 156.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 193.4334,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 155.7738,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 268.182,
          "standard_charge_percentage": 94.0,
          "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": 104.53392,
          "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": 83.62143,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 155.7738,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "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",
          "plan_name": "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": "No payer specific notes",
          "standard_charge_dollar": 242.505,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.917,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.917,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 255.3435,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 255.3435,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 162.621,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.77,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.77,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.203923,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 268.182,
          "standard_charge_percentage": 94.0,
          "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": 135.5175,
          "standard_charge_percentage": 47.5,
          "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": 71.325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B LIPID CPLX (ABELCET) INH SYR",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "57665010141_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.2,
      "maximum": 268.18,
      "gross_charge": 285.3,
      "discounted_cash": 156.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 193.4334,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 155.7738,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 268.182,
          "standard_charge_percentage": 94.0,
          "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": 104.53392,
          "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": 83.62143,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 155.7738,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 242.505,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.917,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.917,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 255.3435,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 255.3435,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 162.621,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.77,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.77,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.203923,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 268.182,
          "standard_charge_percentage": 94.0,
          "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": 135.5175,
          "standard_charge_percentage": 47.5,
          "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": 71.325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B LIPOSOME (AMBISOME) INH SYR",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00469305130",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.31,
      "maximum": 263.95,
      "gross_charge": 280.8,
      "discounted_cash": 154.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 190.3824,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 263.952,
          "standard_charge_percentage": 94.0,
          "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": 102.88512,
          "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": 82.30248,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": "No payer specific notes",
          "standard_charge_dollar": 238.68,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 249.912,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 249.912,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 251.316,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 251.316,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 160.056,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 252.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 252.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.196543,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 263.952,
          "standard_charge_percentage": 94.0,
          "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": 133.38,
          "standard_charge_percentage": 47.5,
          "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": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B LIPOSOME (AMBISOME) INH SYR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00469305130_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.31,
      "maximum": 263.95,
      "gross_charge": 280.8,
      "discounted_cash": 154.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 190.3824,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 263.952,
          "standard_charge_percentage": 94.0,
          "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": 102.88512,
          "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": 82.30248,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": "No payer specific notes",
          "standard_charge_dollar": 238.68,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 249.912,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 249.912,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 251.316,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 251.316,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 160.056,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 252.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 252.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.196543,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 263.952,
          "standard_charge_percentage": 94.0,
          "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": 133.38,
          "standard_charge_percentage": 47.5,
          "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": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B LIPOSOME 2 MG/ML LOCK SYRINGE",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00469305130_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.31,
      "maximum": 329.75,
      "gross_charge": 350.8,
      "discounted_cash": 192.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 237.8424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 329.752,
          "standard_charge_percentage": 94.0,
          "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": 128.53312,
          "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": 102.81948,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.119,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 298.18,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 312.212,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 312.212,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 313.966,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 313.966,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 199.956,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 315.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 315.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.196543,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 329.752,
          "standard_charge_percentage": 94.0,
          "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": 166.63,
          "standard_charge_percentage": 47.5,
          "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": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B LIPOSOME 50 MG IV SUSR",
  "drug_information": {
    "unit": 13.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00469305130_5",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.31,
      "maximum": 615.89,
      "gross_charge": 655.2,
      "discounted_cash": 360.36,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 444.2256,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 615.888,
          "standard_charge_percentage": 94.0,
          "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": 240.06528,
          "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": 192.03912,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.119,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 556.92,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 583.128,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 583.128,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 586.404,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 586.404,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 373.464,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 589.68,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 589.68,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.196543,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 615.888,
          "standard_charge_percentage": 94.0,
          "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": 311.22,
          "standard_charge_percentage": 47.5,
          "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": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B LIPOSOME 50 MG IV SUSR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 13.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00469305130_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.31,
      "maximum": 263.95,
      "gross_charge": 280.8,
      "discounted_cash": 154.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 190.3824,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 263.952,
          "standard_charge_percentage": 94.0,
          "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": 82.30248,
          "standard_charge_percentage": 29.31,
          "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": 102.88512,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.31312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.119,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 238.68,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 249.912,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 249.912,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 251.316,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 251.316,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 160.056,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 252.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 252.72,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.196543,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 263.952,
          "standard_charge_percentage": 94.0,
          "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": 133.38,
          "standard_charge_percentage": 47.5,
          "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": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B OPHTHALMIC SOLN 1.5 MG/ML",
  "drug_information": {
    "unit": 0.05,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "9993000510_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN B OPHTHALMIC SOLN 5 MG/ML",
  "drug_information": {
    "unit": 0.05,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "9993000510",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN INTRAVITREAL INJ (10MCG/0.1ML)",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252000158",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 49.73,
      "maximum": 186.98,
      "gross_charge": 198.92,
      "discounted_cash": 109.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 134.86776,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.61032,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 186.9848,
          "standard_charge_percentage": 94.0,
          "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": 72.884288,
          "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": 58.303452,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 168.68416,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 159.136,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.61032,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 169.082,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 177.0388,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 177.0388,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 178.0334,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 178.0334,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 113.3844,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 179.028,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 179.028,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.61032,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 186.9848,
          "standard_charge_percentage": 94.0,
          "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": 94.487,
          "standard_charge_percentage": 47.5,
          "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": 49.73,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN INTRAVITREAL INJ (5MCG/0.05ML)",
  "drug_information": {
    "unit": 0.05,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "9986000501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 49.67,
      "maximum": 186.76,
      "gross_charge": 198.68,
      "discounted_cash": 109.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 134.70504,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.47928,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 186.7592,
          "standard_charge_percentage": 94.0,
          "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": 58.233108,
          "standard_charge_percentage": 29.31,
          "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": 72.796352,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.47928,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 168.48064,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 158.944,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 168.878,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 176.8252,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 176.8252,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 177.8186,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 177.8186,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 113.2476,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 178.812,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 178.812,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.47928,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 186.7592,
          "standard_charge_percentage": 94.0,
          "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": 94.373,
          "standard_charge_percentage": 47.5,
          "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": 49.67,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPHOTERICIN INTRAVITREAL INJ (5MCG/0.1ML)",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "9986000501_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 49.67,
      "maximum": 186.76,
      "gross_charge": 198.68,
      "discounted_cash": 109.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 134.70504,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.47928,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 186.7592,
          "standard_charge_percentage": 94.0,
          "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": 58.233108,
          "standard_charge_percentage": 29.31,
          "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": 72.796352,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 158.944,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.47928,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 168.48064,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 168.878,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 176.8252,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 176.8252,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 177.8186,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 177.8186,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 113.2476,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 178.812,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 178.812,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.47928,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 186.7592,
          "standard_charge_percentage": 94.0,
          "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": 94.373,
          "standard_charge_percentage": 47.5,
          "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": 49.67,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN 500 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781214501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN SODIUM 1 G IJ SOLR",
  "drug_information": {
    "unit": 4.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781340495",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.51,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN SODIUM 100 MG/ML IJ 500 MG VIAL (RECON)",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781340795",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.51,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN SODIUM 2 G IJ SOLR",
  "drug_information": {
    "unit": 8.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "72485042210",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.51,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN SODIUM 250 MG IJ SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781340295",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.51,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN SODIUM 500 MG IJ SOLR",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781340795_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.51,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN SUBCONJUNCTIVAL INJ (125 MG/0.5 ML)",
  "drug_information": {
    "unit": 0.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252001500",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR",
  "drug_information": {
    "unit": 4.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "25021014220",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.28,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN-SULBACTAM SODIUM 15 (10-5) G IV SOLR",
  "drug_information": {
    "unit": 100.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "55150011899",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.28,
      "maximum": 168.07,
      "gross_charge": 178.8,
      "discounted_cash": 98.34,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 121.2264,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.6248,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 168.072,
          "standard_charge_percentage": 94.0,
          "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": 65.51232,
          "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": 52.40628,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.6248,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 151.98,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 159.132,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 159.132,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 160.026,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 160.026,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 101.916,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 160.92,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 160.92,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 97.6248,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 168.072,
          "standard_charge_percentage": 94.0,
          "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": 84.93,
          "standard_charge_percentage": 47.5,
          "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": 44.7,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR",
  "drug_information": {
    "unit": 8.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "55150011720",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.28,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "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": "25920",
      "type": "HCPCS"
    },
    {
      "code": "25922",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 896.98,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1179.662211,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 1642.82,
          "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": 3342.87,
          "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": 1642.82,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION FOLLOW-UP SURGERY",
  "code_information": [
    {
      "code": "24925",
      "type": "HCPCS"
    },
    {
      "code": "24930",
      "type": "HCPCS"
    },
    {
      "code": "25907",
      "type": "HCPCS"
    },
    {
      "code": "25909",
      "type": "HCPCS"
    },
    {
      "code": "25924",
      "type": "HCPCS"
    },
    {
      "code": "25929",
      "type": "HCPCS"
    },
    {
      "code": "25931",
      "type": "HCPCS"
    },
    {
      "code": "27594",
      "type": "HCPCS"
    },
    {
      "code": "27596",
      "type": "HCPCS"
    },
    {
      "code": "27884",
      "type": "HCPCS"
    },
    {
      "code": "27886",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1150.95,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1348.325433,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 7413.38,
          "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": 2107.97,
          "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": 3342.87,
          "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": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2107.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF FINGER/THUMB",
  "code_information": [
    {
      "code": "26951",
      "type": "HCPCS"
    },
    {
      "code": "26952",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 1825.21,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 3342.87,
          "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": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF MIDFOOT",
  "code_information": [
    {
      "code": "28800",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ana crown exp 1-3 per quad",
  "code_information": [
    {
      "code": "D4231",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "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": 1849.45,
      "maximum": 3387.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1849.44942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1849.44942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2390.466897,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3387.27,
          "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": 3387.27,
          "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": 31.21,
      "maximum": 58.42,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.21482,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.4205,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.21482,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.002414,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANAGRELIDE HCL 0.5 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "13668045301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANAGRELIDE HCL 1 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "13668046201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANAKINRA 100 MG/0.67ML IV SOSY",
  "drug_information": {
    "unit": 0.67,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "66658023407",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 172.29,
      "maximum": 647.8,
      "gross_charge": 689.15,
      "discounted_cash": 379.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 467.2437,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 376.2759,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 647.801,
          "standard_charge_percentage": 94.0,
          "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": 201.989865,
          "standard_charge_percentage": 29.31,
          "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": 252.50456,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 376.2759,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 551.32,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 584.3992,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 585.7775,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 613.3435,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 613.3435,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 616.78925,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 632.6397,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 392.8155,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 620.235,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 620.235,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 376.2759,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 647.801,
          "standard_charge_percentage": 94.0,
          "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": 327.34625,
          "standard_charge_percentage": 47.5,
          "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": 172.2875,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANAKINRA 100 MG/0.67ML SC SOSY",
  "drug_information": {
    "unit": 0.67,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "66658023407_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 172.29,
      "maximum": 647.8,
      "gross_charge": 689.15,
      "discounted_cash": 379.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 467.2437,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 376.2759,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 647.801,
          "standard_charge_percentage": 94.0,
          "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": 252.50456,
          "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": 201.989865,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 551.32,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 376.2759,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 584.3992,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 585.7775,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 613.3435,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 613.3435,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 616.78925,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 616.78925,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 392.8155,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 620.235,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 620.235,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 376.2759,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 647.801,
          "standard_charge_percentage": 94.0,
          "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": 327.34625,
          "standard_charge_percentage": 47.5,
          "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": 172.2875,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANAL SP INF PMP W/REPRG&FILL",
  "code_information": [
    {
      "code": "62369",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 171.33,
      "maximum": 313.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.32934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.32934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.063661,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 313.79,
          "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": 313.79,
          "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": 71.78,
      "maximum": 255.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.37196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.37196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115.326666,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 179.270091,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.26,
          "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": 131.46,
          "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": 255.26,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANALGESIC BALM 10-15 % EX CREA",
  "drug_information": {
    "unit": 85.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "41167006003",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.23,
      "maximum": 4.61,
      "gross_charge": 4.9,
      "discounted_cash": 2.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.3222,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.6753999999999998,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.606,
          "standard_charge_percentage": 94.0,
          "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": 1.79536,
          "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": 1.43619,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 4.1552,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.6753999999999998,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.92,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.165,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.361,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.361,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.3855,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.3855,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.793,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.41,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.41,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.6753999999999998,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.606,
          "standard_charge_percentage": 94.0,
          "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": 2.3275,
          "standard_charge_percentage": 47.5,
          "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": 1.225,
          "standard_charge_percentage": 25.0,
          "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": 29.07,
      "maximum": 53.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.06904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.06904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.383253,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANALYSIS TUMOR",
  "code_information": [
    {
      "code": "88358",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 95.04,
      "maximum": 174.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.03676,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.03676,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 126.309456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 174.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 174.06,
          "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": 171.33,
      "maximum": 313.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.32934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.32934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.063661,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 313.79,
          "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": 313.79,
          "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": 171.33,
      "maximum": 313.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.32934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.32934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.063661,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 313.79,
          "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": 313.79,
          "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": 19.16,
      "maximum": 35.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.15914,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.15914,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.864839,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 0.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.41,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANASTROZOLE 1 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687011221",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "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": 6.58,
      "maximum": 12.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.882055,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 6.58,
      "maximum": 12.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.882055,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ANDROLOGY INFERTILITY ASSMT",
  "code_information": [
    {
      "code": "0255U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17.25,
      "maximum": 31.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.2536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.2536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.29236,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 15.74,
      "maximum": 28.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.74118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.74118,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.250593,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ANGIOTENSIN I ENZYME TEST",
  "code_information": [
    {
      "code": "82164",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.97,
      "maximum": 14.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.9716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.9716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.76166,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ANGIOTENSIN II ACETATE 2.5 MG/ML IV SOLN",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68547050102",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1215.0,
      "maximum": 4568.4,
      "gross_charge": 4860.0,
      "discounted_cash": 2673.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3295.08,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.56,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4568.4,
          "standard_charge_percentage": 94.0,
          "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": 1780.704,
          "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": 1424.466,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.56,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 4121.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3888.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4131.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4325.4,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4325.4,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4349.7,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4349.7,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2770.2,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4374.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4374.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.56,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4568.4,
          "standard_charge_percentage": 94.0,
          "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": 2308.5,
          "standard_charge_percentage": 47.5,
          "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": 1215.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANIDULAFUNGIN 100 MG IV SOLR",
  "drug_information": {
    "unit": 30.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00049011628",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.42,
      "maximum": 221.79,
      "gross_charge": 235.95,
      "discounted_cash": 129.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 159.9741,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 128.8287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.793,
          "standard_charge_percentage": 94.0,
          "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": 69.156945,
          "standard_charge_percentage": 29.31,
          "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": 86.45208,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.95,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 128.8287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 200.5575,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 209.9955,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 209.9955,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 211.17525,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 211.17525,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 134.4915,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 212.355,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 212.355,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 128.8287,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 221.793,
          "standard_charge_percentage": 94.0,
          "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": 112.07625,
          "standard_charge_percentage": 47.5,
          "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": 58.9875,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANIDULAFUNGIN 50 MG IV SOLR",
  "drug_information": {
    "unit": 15.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00049011428",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.42,
      "maximum": 92.4,
      "gross_charge": 98.3,
      "discounted_cash": 54.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.6474,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.6718,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.402,
          "standard_charge_percentage": 94.0,
          "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": 36.01712,
          "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": 28.81173,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.6718,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.95,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 83.555,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 87.487,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 87.487,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 87.9785,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 87.9785,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.031,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.47,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.47,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.6718,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 92.402,
          "standard_charge_percentage": 94.0,
          "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": 46.6925,
          "standard_charge_percentage": 47.5,
          "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": 24.575,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "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": 1825.21,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANKLE DISARTICULATION",
  "code_information": [
    {
      "code": "27889",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 171.33,
      "maximum": 313.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.32934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.32934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.063661,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 313.79,
          "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": 313.79,
          "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": 20.9,
      "maximum": 38.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.90088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.958209,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.28,
          "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": 112.78,
      "maximum": 206.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112.7763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112.7763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 148.282407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 206.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 206.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANORECTAL MANOMETRY",
  "code_information": [
    {
      "code": "91122",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 229.53,
      "maximum": 229.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 229.53294,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANORECTAL MYOMECTOMY",
  "code_information": [
    {
      "code": "45108",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1548.34,
      "maximum": 2835.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1548.33588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1548.33588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2021.415669,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2835.78,
          "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": 2835.78,
          "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": 667.52,
      "maximum": 1222.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 667.51776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 667.51776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1222.56,
          "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": 1222.56,
          "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": 518.75,
      "maximum": 2835.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.7546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1548.33588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.7546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1548.33588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 672.021441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2021.415669,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 950.1,
          "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": 2835.78,
          "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": 950.1,
          "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": 2835.78,
          "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": 667.52,
      "maximum": 1222.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 667.51776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 667.51776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 869.099868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1222.56,
          "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": 1222.56,
          "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": 667.52,
      "maximum": 1222.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 667.51776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 667.51776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 869.099868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1222.56,
          "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": 1222.56,
          "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": 667.52,
      "maximum": 1222.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 667.51776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 667.51776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 869.099868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1222.56,
          "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": 1222.56,
          "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": 518.75,
      "maximum": 950.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.7546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.7546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 672.021441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 950.1,
          "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": 950.1,
          "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": 1548.34,
      "maximum": 2835.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1548.33588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1548.33588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2021.415669,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2835.78,
          "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": 2835.78,
          "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": 1548.34,
      "maximum": 2835.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1548.33588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1548.33588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2021.415669,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2835.78,
          "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": 2835.78,
          "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": 208.16,
      "maximum": 381.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.15704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.15704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.24,
          "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": 120.45,
      "maximum": 229.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 120.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 120.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 229.53294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 220.6,
          "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": 220.6,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "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": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "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": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 17.11,
      "maximum": 31.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.10618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.10618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.093343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 1805.75,
      "maximum": 3307.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1805.75304,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1805.75304,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2343.631563,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3307.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3307.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTERIOR COLPORRHAPHY",
  "code_information": [
    {
      "code": "57240",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2790.5,
      "maximum": 5110.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2790.4968,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2790.4968,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3638.657295,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5110.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5110.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTI-PHOSPHOLIPID ANTIBODY",
  "code_information": [
    {
      "code": "86148",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.77,
      "maximum": 16.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.77422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.77422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.845197,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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-THYMOCYTE GLOB (RABBIT) 25 MG IV SOLR",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58468008001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 551.32,
      "maximum": 2605.68,
      "gross_charge": 2772.0,
      "discounted_cash": 1524.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1879.416,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 1015.6608,
          "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": 812.4732,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1141.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2356.2,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1580.04,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 705.213054,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 1316.7,
          "standard_charge_percentage": 47.5,
          "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": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTI-THYMOCYTE GLOB (RABBIT) 25 MG IV SOLR (MIXTURE USE)",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58468008001_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 551.32,
      "maximum": 2605.68,
      "gross_charge": 2772.0,
      "discounted_cash": 1524.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1879.416,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 812.4732,
          "standard_charge_percentage": 29.31,
          "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": 1015.6608,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1141.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2356.2,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1580.04,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 705.213054,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 1316.7,
          "standard_charge_percentage": 47.5,
          "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": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIBODY DETECTION NOS IF",
  "code_information": [
    {
      "code": "87299",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.79,
      "maximum": 16.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.7906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.7906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.86731,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 28.08,
      "maximum": 51.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.08078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.08078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.909053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTICOAGULANT SODIUM CITRATE 46.7 % VI CONC",
  "drug_information": {
    "unit": 30.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "23731603003",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.0,
      "maximum": 282.0,
      "gross_charge": 300.0,
      "discounted_cash": 165.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 203.4,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.8,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 282.0,
          "standard_charge_percentage": 94.0,
          "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": 87.93,
          "standard_charge_percentage": 29.31,
          "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": 109.92,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.8,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 240.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 254.4,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 255.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 267.0,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 267.0,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 268.5,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 275.4,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 171.0,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 270.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 270.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.8,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 282.0,
          "standard_charge_percentage": 94.0,
          "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": 142.5,
          "standard_charge_percentage": 47.5,
          "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": 75.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "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": 26.12,
      "maximum": 73.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.16376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.16376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.009794,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.459407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 73.56,
          "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": 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": 73.56,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTIHEM FACTOR RECOMB (RFVIII) 1000 UNITS IV KIT",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00026378555_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.9975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEM FACTOR RECOMB (RFVIII) 1000 UNITS IV KIT|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00026378555",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.68,
      "maximum": 2.19,
      "gross_charge": 2.33,
      "discounted_cash": 1.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.57974,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.1902,
          "standard_charge_percentage": 94.0,
          "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": 0.853712,
          "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": 0.682923,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.398,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.864,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.9805,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.0737,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.0737,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.08535,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.08535,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.3281,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.097,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.097,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.1902,
          "standard_charge_percentage": 94.0,
          "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": 1.10675,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEM FACTOR RECOMB (RFVIII) 801-1240 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944284310_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.9975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEM FACTOR RECOMB (RFVIII) 801-1240 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944284310",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 2.85,
      "gross_charge": 3.03,
      "discounted_cash": 1.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.05434,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.8482,
          "standard_charge_percentage": 94.0,
          "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": 0.888093,
          "standard_charge_percentage": 29.31,
          "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": 1.110192,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.818,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.5755,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.6967,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.6967,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.71185,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.71185,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.7271,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.727,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.727,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.8482,
          "standard_charge_percentage": 94.0,
          "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": 1.43925,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHIL FACTOR (RAHF-PFM) 2000 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944304510_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.9975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHIL FACTOR (RAHF-PFM) 2000 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944304510",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 2.86,
      "gross_charge": 3.04,
      "discounted_cash": 1.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.06112,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.8576,
          "standard_charge_percentage": 94.0,
          "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": 0.891024,
          "standard_charge_percentage": 29.31,
          "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": 1.113856,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.584,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7056,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7056,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7208,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7208,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.7328,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.736,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.736,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.8576,
          "standard_charge_percentage": 94.0,
          "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": 1.444,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHIL FACTOR (RAHF-PFM) 500 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944305202_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.9975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHIL FACTOR (RAHF-PFM) 500 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944305202",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.77,
      "maximum": 2.47,
      "gross_charge": 2.63,
      "discounted_cash": 1.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.78314,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.4722,
          "standard_charge_percentage": 94.0,
          "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": 0.963632,
          "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": 0.770853,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.578,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.2355,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.3407,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.3407,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.35385,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.35385,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4991,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.367,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.367,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.4722,
          "standard_charge_percentage": 94.0,
          "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": 1.24925,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR 1000 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944394402_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.61,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4705,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.862407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR 1000 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944394402",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.61,
      "maximum": 2.9,
      "gross_charge": 3.08,
      "discounted_cash": 1.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.08824,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.8952,
          "standard_charge_percentage": 94.0,
          "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": 0.902748,
          "standard_charge_percentage": 29.31,
          "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": 1.128512,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4705,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.618,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7412,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7412,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7566,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7566,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.7556,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.772,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.772,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.862407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.8952,
          "standard_charge_percentage": 94.0,
          "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": 1.463,
          "standard_charge_percentage": 47.5,
          "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": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR 1700 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "F2"
  },
  "code_information": [
    {
      "code": "00944394602_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.61,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4705,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.862407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR 1700 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "F2"
  },
  "code_information": [
    {
      "code": "00944394602",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.57,
      "maximum": 1.82,
      "gross_charge": 1.94,
      "discounted_cash": 1.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.31532,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.8236,
          "standard_charge_percentage": 94.0,
          "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": 0.710816,
          "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": 0.568614,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.649,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.7266,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.7266,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.7363,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.7363,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.1058,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.746,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.746,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.862407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8236,
          "standard_charge_percentage": 94.0,
          "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": 0.9215,
          "standard_charge_percentage": 47.5,
          "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": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR RAHF-PAF (XYNTHA)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58394001401_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.5,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 93.28,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 88.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.06,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 27.5,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR RAHF-PAF (XYNTHA)|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58394001401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.53,
      "maximum": 2.0,
      "gross_charge": 2.13,
      "discounted_cash": 1.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.44414,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.16298,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0022,
          "standard_charge_percentage": 94.0,
          "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": 0.780432,
          "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": 0.624303,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.16298,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 1.80624,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 1.704,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8105,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8957,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8957,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.90635,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.90635,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.2141,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.917,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.917,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.16298,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.0022,
          "standard_charge_percentage": 94.0,
          "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": 1.01175,
          "standard_charge_percentage": 47.5,
          "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": 0.5325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR VIII (KOATE DVI)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944394402_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.61,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4705,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.862407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR VIII (KOATE DVI)|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944394402_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.61,
      "maximum": 2.9,
      "gross_charge": 3.08,
      "discounted_cash": 1.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.08824,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.8952,
          "standard_charge_percentage": 94.0,
          "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": 0.902748,
          "standard_charge_percentage": 29.31,
          "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": 1.128512,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4705,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.60606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.618,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7412,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7412,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7566,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.7566,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.7556,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.772,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.772,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.862407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.8952,
          "standard_charge_percentage": 94.0,
          "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": 1.463,
          "standard_charge_percentage": 47.5,
          "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": 1.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR VIII RECOMBINANT (ADVATE)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944305302_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.9975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR VIII RECOMBINANT (ADVATE)|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00944305302",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 3.06,
      "gross_charge": 3.26,
      "discounted_cash": 1.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.21028,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.0644,
          "standard_charge_percentage": 94.0,
          "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": 0.955506,
          "standard_charge_percentage": 29.31,
          "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": 1.194464,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.771,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.9014,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.9014,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.9177,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.9177,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.8582,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.934,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.934,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.0644,
          "standard_charge_percentage": 94.0,
          "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": 1.5485,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR VIII RECOMBINANT (KOGENATE FS)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00026378555_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.87,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.9975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR VIII RECOMBINANT (KOGENATE FS)|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00026378555_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.68,
      "maximum": 2.19,
      "gross_charge": 2.33,
      "discounted_cash": 1.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.57974,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.1902,
          "standard_charge_percentage": 94.0,
          "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": 0.853712,
          "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": 0.682923,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.398,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.86814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.864,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.9805,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.0737,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.0737,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.08535,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.08535,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.3281,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.097,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.097,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.142505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.1902,
          "standard_charge_percentage": 94.0,
          "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": 1.10675,
          "standard_charge_percentage": 47.5,
          "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": 1.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-FVIII (ALPHANATE) IV SYRINGE",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461802_6",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.68,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-FVIII (ALPHANATE) IV SYRINGE|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461802",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.64,
      "maximum": 2.07,
      "gross_charge": 2.2,
      "discounted_cash": 1.21,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4916,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.068,
          "standard_charge_percentage": 94.0,
          "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": 0.80608,
          "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": 0.64482,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.87,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.969,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.969,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.254,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.98,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.98,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.068,
          "standard_charge_percentage": 94.0,
          "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": 1.045,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF (ALPHANATE)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461802_7",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.68,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF (ALPHANATE) IV SYRINGE",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461802_8",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.68,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF (ALPHANATE) IV SYRINGE|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461802_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.64,
      "maximum": 2.07,
      "gross_charge": 2.2,
      "discounted_cash": 1.21,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4916,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.068,
          "standard_charge_percentage": 94.0,
          "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": 0.64482,
          "standard_charge_percentage": 29.31,
          "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": 0.80608,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.87,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.969,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.969,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.254,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.98,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.98,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.068,
          "standard_charge_percentage": 94.0,
          "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": 1.045,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF (ALPHANATE)|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461802_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.64,
      "maximum": 2.07,
      "gross_charge": 2.2,
      "discounted_cash": 1.21,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4916,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.068,
          "standard_charge_percentage": 94.0,
          "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": 0.64482,
          "standard_charge_percentage": 29.31,
          "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": 0.80608,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.87,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.969,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.969,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.254,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.98,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.98,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.068,
          "standard_charge_percentage": 94.0,
          "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": 1.045,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF 1000 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461802_5",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.68,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF 1000 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461802_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.64,
      "maximum": 2.07,
      "gross_charge": 2.2,
      "discounted_cash": 1.21,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4916,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.068,
          "standard_charge_percentage": 94.0,
          "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": 0.64482,
          "standard_charge_percentage": 29.31,
          "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": 0.80608,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.87,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.969,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.969,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.254,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.98,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.98,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.068,
          "standard_charge_percentage": 94.0,
          "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": 1.045,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF 250-600 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "63833061502_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.81,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.81354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.81354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.683,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.03194,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 1.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF 250-600 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "63833061502",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.78,
      "maximum": 2.5,
      "gross_charge": 2.66,
      "discounted_cash": 1.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.80348,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.81354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.5004,
          "standard_charge_percentage": 94.0,
          "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": 0.779646,
          "standard_charge_percentage": 29.31,
          "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": 0.974624,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.596,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.81354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.261,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.3674,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.3674,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.3807,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.3807,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.5162,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.394,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.394,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.03194,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.5004,
          "standard_charge_percentage": 94.0,
          "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": 1.2635,
          "standard_charge_percentage": 47.5,
          "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": 1.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF 500 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461701_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.68,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF 500 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516461701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.61,
      "maximum": 1.95,
      "gross_charge": 2.07,
      "discounted_cash": 1.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.40346,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.9458,
          "standard_charge_percentage": 94.0,
          "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": 0.606717,
          "standard_charge_percentage": 29.31,
          "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": 0.758448,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.242,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.67704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.7595,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8423,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8423,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.85265,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.85265,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.1799,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.863,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.863,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.906633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.9458,
          "standard_charge_percentage": 94.0,
          "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": 0.98325,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF 500-1200 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "63833061602_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.81,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.81354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.683,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.81354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.03194,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 1.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIHEMOPHILIC FACTOR-VWF 500-1200 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "63833061602",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.61,
      "maximum": 1.96,
      "gross_charge": 2.08,
      "discounted_cash": 1.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.41024,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.81354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.9552,
          "standard_charge_percentage": 94.0,
          "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": 0.609648,
          "standard_charge_percentage": 29.31,
          "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": 0.762112,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.81354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.248,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 1.664,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.768,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8512,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8512,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8616,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.8616,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.1856,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.872,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.872,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.03194,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.9552,
          "standard_charge_percentage": 94.0,
          "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": 0.988,
          "standard_charge_percentage": 47.5,
          "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": 1.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "64193042402_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.33,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.32678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "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": 40.304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.32678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.724814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 2.43,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "64193042402",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.24,
      "maximum": 3.98,
      "gross_charge": 4.23,
      "discounted_cash": 2.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.86794,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.32678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.9762,
          "standard_charge_percentage": 94.0,
          "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": 1.239813,
          "standard_charge_percentage": 29.31,
          "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": 1.549872,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.32678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 2.538,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.5955,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.7647,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.7647,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.78585,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.78585,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.4111,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.807,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.807,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.724814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.9762,
          "standard_charge_percentage": 94.0,
          "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": 2.00925,
          "standard_charge_percentage": 47.5,
          "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": 2.43,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "64193042502_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.33,
      "maximum": 103.4,
      "gross_charge": 110.0,
      "discounted_cash": 60.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.58,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.32678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 40.304,
          "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": 32.241,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.32678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.5,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.9,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.45,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.724814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 103.4,
          "standard_charge_percentage": 94.0,
          "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": 52.25,
          "standard_charge_percentage": 47.5,
          "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": 2.43,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "64193042502",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.15,
      "maximum": 3.69,
      "gross_charge": 3.93,
      "discounted_cash": 2.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.66454,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.32678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.6942,
          "standard_charge_percentage": 94.0,
          "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": 1.439952,
          "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": 1.151883,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Fee Schedule rate method subject to lesser of provisions, negotiated rate adjusted to reflect standard_charge|gross",
          "standard_charge_dollar": 2.358,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.32678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.3405,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4977,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4977,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.51735,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.51735,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.2401,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.537,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.537,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.724814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6942,
          "standard_charge_percentage": 94.0,
          "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": 1.86675,
          "standard_charge_percentage": 47.5,
          "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": 2.43,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTINOMYCES ANTIBODY",
  "code_information": [
    {
      "code": "86602",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.56,
      "maximum": 10.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.55828,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.55828,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.503678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 6.6,
      "maximum": 12.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.60114,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.60114,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.911539,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 6.09,
      "maximum": 11.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.09336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.09336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.226036,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 3.15,
      "maximum": 5.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.15042,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.15042,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.253067,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 3.99,
      "maximum": 7.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.9858,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.9858,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.38083,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 6.47,
      "maximum": 11.85,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.4701,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.4701,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.734635,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 5.9,
      "maximum": 10.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.90226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.90226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.968051,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 III HUMAN (THROMBATE III)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "13533060612_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.21,
      "maximum": 4590.2,
      "gross_charge": 4883.19,
      "discounted_cash": 2685.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3310.80282,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.2113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4590.1986,
          "standard_charge_percentage": 94.0,
          "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": 1789.200816,
          "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": 1431.262989,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.352,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.2113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4150.7115,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4346.0391,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4346.0391,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4370.45505,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4370.45505,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2783.4183,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4394.871,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4394.871,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.837835,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4590.1986,
          "standard_charge_percentage": 94.0,
          "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": 2319.51525,
          "standard_charge_percentage": 47.5,
          "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": 4.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTITHROMBIN III HUMAN (THROMBATE III)|DISCARDED DRUG NOT ADMINISTERED",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "13533060612",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.21,
      "maximum": 4524.4,
      "gross_charge": 4813.19,
      "discounted_cash": 2647.25,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3263.34282,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.2113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4524.3986,
          "standard_charge_percentage": 94.0,
          "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": 1410.745989,
          "standard_charge_percentage": 29.31,
          "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": 1763.552816,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.2113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.352,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4091.2115,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4283.7391,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4283.7391,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4307.80505,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4307.80505,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2743.5183,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4331.871,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4331.871,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.837835,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4524.3986,
          "standard_charge_percentage": 94.0,
          "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": 2286.26525,
          "standard_charge_percentage": 47.5,
          "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": 4.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Antithrombin recombinant",
  "code_information": [
    {
      "code": "J7196",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 143.31,
      "maximum": 143.31,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 143.31,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANTITHYMOCYTE GLOBULIN (RABBIT) SKIN TEST",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58468008001_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 551.32,
      "maximum": 2605.68,
      "gross_charge": 2772.0,
      "discounted_cash": 1524.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1879.416,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 812.4732,
          "standard_charge_percentage": 29.31,
          "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": 1015.6608,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1141.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "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": "No payer specific notes",
          "standard_charge_dollar": 2356.2,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1580.04,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 705.213054,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 1316.7,
          "standard_charge_percentage": 47.5,
          "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": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTITHYMOCYTE GLOBULIN (RABBIT) SKIN TEST (1:10 DILUTION) VIAL",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58468008001_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 551.32,
      "maximum": 2605.68,
      "gross_charge": 2772.0,
      "discounted_cash": 1524.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1879.416,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 1015.6608,
          "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": 812.4732,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1141.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "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": "No payer specific notes",
          "standard_charge_dollar": 2356.2,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1580.04,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 705.213054,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 1316.7,
          "standard_charge_percentage": 47.5,
          "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": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTITHYMOCYTE GLOBULIN (RABBIT) SKIN TEST (1:100 DILUTION) VIAL",
  "drug_information": {
    "unit": 0.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58468008001_5",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 551.32,
      "maximum": 2605.68,
      "gross_charge": 2772.0,
      "discounted_cash": 1524.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1879.416,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 1015.6608,
          "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": 812.4732,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 551.3235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1141.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "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": "No payer specific notes",
          "standard_charge_dollar": 2356.2,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2467.08,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2480.94,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1580.04,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2494.8,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 705.213054,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2605.68,
          "standard_charge_percentage": 94.0,
          "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": 1316.7,
          "standard_charge_percentage": 47.5,
          "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": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTIVENIN LATRODECTUS MACTANS IJ KIT",
  "drug_information": {
    "unit": 2.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00006542402",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17.32,
      "maximum": 65.12,
      "gross_charge": 69.28,
      "discounted_cash": 38.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 46.97184,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.82688,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.1232,
          "standard_charge_percentage": 94.0,
          "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": 20.305968,
          "standard_charge_percentage": 29.31,
          "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": 25.384192,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.82688,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 55.424,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 58.74944,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58.888,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.6592,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.6592,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.59904,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.0056,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 39.4896,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.352,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.352,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.82688,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.1232,
          "standard_charge_percentage": 94.0,
          "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": 32.908,
          "standard_charge_percentage": 47.5,
          "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": 17.32,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTMC GUIDE 3D PRINT 1ST GD",
  "code_information": [
    {
      "code": "0561T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 43.78,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.78374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "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": 43.78,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.78374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AORTIC DYSFUNCTION/DILATION",
  "code_information": [
    {
      "code": "81410",
      "type": "HCPCS"
    },
    {
      "code": "81411",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 275.18,
      "maximum": 1350.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 275.184,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 737.20374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 275.184,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 737.20374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 371.4984,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 995.225049,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 109.2,
      "maximum": 200.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 109.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 109.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 147.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 425.88,
      "maximum": 780.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 425.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 425.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 574.938,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 152.88,
      "maximum": 280.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 152.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 152.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 206.388,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 154.45,
      "maximum": 282.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 154.45248,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 154.45248,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.510848,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "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": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "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": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "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": 32.91,
      "maximum": 60.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.90742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.90742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.78374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.27,
          "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": 60.27,
          "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": 2429.61,
      "maximum": 4449.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2429.61264,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2429.61264,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3453.438807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4449.84,
          "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": 4449.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS PLASMA",
  "code_information": [
    {
      "code": "36514",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 868.77,
      "maximum": 1591.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 868.77336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 868.77336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1208.313288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1591.16,
          "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": 1591.16,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS PLATELETS",
  "code_information": [
    {
      "code": "36513",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 246.1,
      "maximum": 450.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 246.09858,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 246.09858,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 322.245378,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 450.73,
          "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": 450.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS RBC",
  "code_information": [
    {
      "code": "36512",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 868.77,
      "maximum": 1591.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 868.77336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 868.77336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1208.313288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1591.16,
          "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": 1591.16,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS WBC",
  "code_information": [
    {
      "code": "36511",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 868.77,
      "maximum": 1591.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 868.77336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 868.77336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1208.313288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1591.16,
          "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": 1591.16,
          "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": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apicoectomy - anterior",
  "code_information": [
    {
      "code": "D3410",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 360.63,
      "maximum": 1225.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 360.62754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.524573,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.49,
          "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": 660.49,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APIXABAN 2.5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00003089331",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "APIXABAN 5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00003089431",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Apligraf",
  "code_information": [
    {
      "code": "Q4101",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APOL1 RISK VARIANTS",
  "code_information": [
    {
      "code": "0355U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apomorphine hydrochloride",
  "code_information": [
    {
      "code": "J0364",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 35.41,
      "maximum": 35.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.411,
          "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": 9.73,
      "maximum": 17.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.72972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.72972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.803427,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 25.49,
      "maximum": 46.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.48728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.48728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.825519,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 13.25,
      "maximum": 24.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.25142,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.25142,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.557722,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 9.93,
      "maximum": 18.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.92628,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.92628,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.061412,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 13555.31,
      "maximum": 27721.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15136.06458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15136.06458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27721.73,
          "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": 27721.73,
          "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": 896.98,
      "maximum": 1642.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1179.662211,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1642.82,
          "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": 1642.82,
          "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": 1150.95,
      "maximum": 2107.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1348.325433,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2107.97,
          "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": 2107.97,
          "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": 1150.95,
      "maximum": 2107.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1348.325433,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2107.97,
          "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": 2107.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPENDECTOMY",
  "code_information": [
    {
      "code": "44950",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3611.27,
      "maximum": 6614.04,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3611.26584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3611.26584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4599.319725,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6614.04,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6614.04,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL BDY CST SHO TO HIP 1THI",
  "code_information": [
    {
      "code": "29044",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 32.91,
      "maximum": 60.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.90742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.90742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.78374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.27,
          "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": 60.27,
          "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": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "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": 896.98,
      "maximum": 1642.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1642.82,
          "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": 1642.82,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 10.43,
      "maximum": 19.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.43406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.43406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.724802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 20.84,
      "maximum": 38.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.931175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.16,
          "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": 38.16,
          "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": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "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": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 896.98,
      "maximum": 1642.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1642.82,
          "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": 1642.82,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 896.98,
      "maximum": 1642.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1179.662211,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1642.82,
          "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": 1642.82,
          "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": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 156.02,
      "maximum": 285.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 156.0195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 195.759018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 285.75,
          "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": 285.75,
          "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": 90.65,
      "maximum": 166.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.64692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.307009,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 166.02,
          "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": 26.12,
      "maximum": 47.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.009794,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "APPLY INTERSTIT RADIAT COMPL",
  "code_information": [
    {
      "code": "77778",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 388.51,
      "maximum": 711.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 388.51176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 388.51176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 511.407351,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 711.56,
          "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": 711.56,
          "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": 388.51,
      "maximum": 711.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 388.51176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 388.51176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 511.407351,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 711.56,
          "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": 711.56,
          "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": 308.22,
      "maximum": 564.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 308.22246,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 308.22246,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 426.390237,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 564.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 564.51,
          "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": 308.22,
      "maximum": 564.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 308.22246,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 308.22246,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 426.390237,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 564.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 564.51,
          "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": 896.98,
      "maximum": 1642.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 896.97972,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1179.662211,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1642.82,
          "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": 1642.82,
          "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": 56.92,
      "maximum": 104.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.91504,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.91504,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 80.71245,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 104.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 104.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APRACLONIDINE HCL 0.5 % OP SOLN",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "61314066505",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 23.73,
      "maximum": 89.23,
      "gross_charge": 94.93,
      "discounted_cash": 52.21,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 64.36254,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.83178,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.2342,
          "standard_charge_percentage": 94.0,
          "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": 34.782352,
          "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": 27.823983,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.83178,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 80.50064,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 75.944,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.6905,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 84.4877,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 84.4877,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 84.96235,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 84.96235,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 54.1101,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 85.437,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 85.437,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.83178,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.2342,
          "standard_charge_percentage": 94.0,
          "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": 45.09175,
          "standard_charge_percentage": 47.5,
          "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": 23.7325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "APRACLONIDINE HCL 1 % OP SOLN",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "82667020001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.67,
      "maximum": 141.64,
      "gross_charge": 150.68,
      "discounted_cash": 82.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 102.16104,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 82.27128,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 141.6392,
          "standard_charge_percentage": 94.0,
          "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": 55.209152,
          "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": 44.164308,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 127.77664,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 82.27128,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 120.544,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 128.078,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.1052,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.1052,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.8586,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.8586,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 85.8876,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 135.612,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 135.612,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 82.27128,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 141.6392,
          "standard_charge_percentage": 94.0,
          "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": 71.573,
          "standard_charge_percentage": 47.5,
          "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": 37.67,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "APREPITANT 125 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781232368",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.14,
      "maximum": 539.17,
      "gross_charge": 573.59,
      "discounted_cash": 315.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 388.89402,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 313.18014,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 539.1746,
          "standard_charge_percentage": 94.0,
          "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": 210.163376,
          "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": 168.119229,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.169,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 313.18014,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 487.5515,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 510.4951,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 510.4951,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 513.36305,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 513.36305,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 326.9463,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 516.231,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 516.231,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 313.18014,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 539.1746,
          "standard_charge_percentage": 94.0,
          "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": 272.45525,
          "standard_charge_percentage": 47.5,
          "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": 143.3975,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "APREPITANT 40 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781232151",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.14,
      "maximum": 189.53,
      "gross_charge": 201.63,
      "discounted_cash": 110.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 136.70514,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 110.08998,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 189.5322,
          "standard_charge_percentage": 94.0,
          "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": 73.877232,
          "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": 59.097753,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.169,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 110.08998,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 171.3855,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 179.4507,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 179.4507,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 180.45885,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 180.45885,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 114.9291,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.467,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.467,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 110.08998,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.5322,
          "standard_charge_percentage": 94.0,
          "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": 95.77425,
          "standard_charge_percentage": 47.5,
          "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": 50.4075,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "APREPITANT 80 & 125 MG PO MISC",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00006386203",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.14,
      "maximum": 2307.28,
      "gross_charge": 2454.55,
      "discounted_cash": 1350.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1664.1849,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1340.1843,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2307.277,
          "standard_charge_percentage": 94.0,
          "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": 719.428605,
          "standard_charge_percentage": 29.31,
          "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": 899.34712,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1340.1843,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.169,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2086.3675,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2184.5495,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2184.5495,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2196.82225,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2196.82225,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1399.0935,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2209.095,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2209.095,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1340.1843,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2307.277,
          "standard_charge_percentage": 94.0,
          "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": 1165.91125,
          "standard_charge_percentage": 47.5,
          "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": 613.6375,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "APREPITANT 80 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00781232268",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.14,
      "maximum": 409.83,
      "gross_charge": 435.99,
      "discounted_cash": 239.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 295.60122,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 238.05054,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 409.8306,
          "standard_charge_percentage": 94.0,
          "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": 127.788669,
          "standard_charge_percentage": 29.31,
          "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": 159.746736,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 238.05054,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.169,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 370.5915,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 388.0311,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 388.0311,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 390.21105,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 390.21105,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 248.5143,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 392.391,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 392.391,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 238.05054,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 409.8306,
          "standard_charge_percentage": 94.0,
          "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": 207.09525,
          "standard_charge_percentage": 47.5,
          "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": 108.9975,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AQAPRN-4 ANTB FLO CYTMTRY EA",
  "code_information": [
    {
      "code": "86053",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.6,
      "maximum": 37.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.60058,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.60058,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.810783,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "AQUADEKS PO CHEW",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R5891401460",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AQUADEKS PO SOLN",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "58204000404",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AQUANIL SKIN CLEANSER EX LOTN",
  "drug_information": {
    "unit": 480.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00096072416",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.81,
      "maximum": 25.6,
      "gross_charge": 27.23,
      "discounted_cash": 14.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 18.46194,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.86758,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 25.5962,
          "standard_charge_percentage": 94.0,
          "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": 9.977072,
          "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": 7.981113,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 23.09104,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 21.784,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.86758,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.1455,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.2347,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.2347,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.37085,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.37085,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.5211,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.507,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.507,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.86758,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.5962,
          "standard_charge_percentage": 94.0,
          "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": 12.93425,
          "standard_charge_percentage": 47.5,
          "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": 6.8075,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AQUAPHOR ADVANCED THERAPY EX OINT",
  "drug_information": {
    "unit": 396.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "72140063608",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.19,
      "maximum": 38.31,
      "gross_charge": 40.75,
      "discounted_cash": 22.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.6285,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.2495,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 38.305,
          "standard_charge_percentage": 94.0,
          "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": 11.943825,
          "standard_charge_percentage": 29.31,
          "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": 14.9308,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.2495,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 34.556,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.6,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.6375,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.2675,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.2675,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.47125,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.47125,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.2275,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.675,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.675,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.2495,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.305,
          "standard_charge_percentage": 94.0,
          "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": 19.35625,
          "standard_charge_percentage": 47.5,
          "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": 10.1875,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AQUAPHOR EX OINT",
  "drug_information": {
    "unit": 50.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "72140045231",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.38,
      "maximum": 12.72,
      "gross_charge": 13.53,
      "discounted_cash": 7.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.17334,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.38738,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.7182,
          "standard_charge_percentage": 94.0,
          "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": 3.965643,
          "standard_charge_percentage": 29.31,
          "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": 4.957392,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 10.824,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 11.47344,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.38738,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.5005,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.0417,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.0417,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.10935,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.10935,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.7121,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.177,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.177,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.38738,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.7182,
          "standard_charge_percentage": 94.0,
          "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": 6.42675,
          "standard_charge_percentage": 47.5,
          "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": 3.3825,
          "standard_charge_percentage": 25.0,
          "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": 6.58,
      "maximum": 12.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.5793,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.882055,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 6.3,
      "maximum": 11.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.29538,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.29538,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.498763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 26.12,
      "maximum": 47.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.12064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.621587,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 2968.36,
      "maximum": 5436.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2968.36176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2968.36176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3803.222241,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5436.56,
          "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": 5436.56,
          "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": 2968.36,
      "maximum": 5436.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2968.36176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2968.36176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3803.222241,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5436.56,
          "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": 5436.56,
          "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": 164.54,
      "maximum": 301.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 164.5371,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 164.5371,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 222.125085,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 164.54,
      "maximum": 301.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 164.5371,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 164.5371,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 222.125085,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 101.12,
      "maximum": 185.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 101.1192,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 101.1192,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.51092,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "Architect ecm px fx 1 sq cm",
  "code_information": [
    {
      "code": "Q4147",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ardeograft, per sq cm",
  "code_information": [
    {
      "code": "Q4333",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "69097016864",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGATROBAN 250 MG/2.5ML IV SOLN",
  "drug_information": {
    "unit": 2.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00143967401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.33,
      "maximum": 566.18,
      "gross_charge": 602.32,
      "discounted_cash": 331.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 408.37296,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.3276,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 566.1808,
          "standard_charge_percentage": 94.0,
          "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": 220.690048,
          "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": 176.539992,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.3276,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 511.972,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 536.0648,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 536.0648,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 539.0764,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 539.0764,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 343.3224,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 542.088,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 542.088,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.928746,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 566.1808,
          "standard_charge_percentage": 94.0,
          "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": 286.102,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGATROBAN 250 MG/250 ML DRIP (STRAIGHT DRUG) (MULTI-GPI)",
  "drug_information": {
    "unit": 250.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00000198801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 544.1,
      "maximum": 2045.82,
      "gross_charge": 2176.4,
      "discounted_cash": 1197.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1475.5992,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1188.3144,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2045.816,
          "standard_charge_percentage": 94.0,
          "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": 797.43296,
          "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": 637.90284,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 1741.12,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 1845.5872,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1188.3144,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1849.94,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1936.996,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1936.996,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1947.878,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1947.878,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1240.548,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1958.76,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1958.76,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1188.3144,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2045.816,
          "standard_charge_percentage": 94.0,
          "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": 1033.79,
          "standard_charge_percentage": 47.5,
          "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": 544.1,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGATROBAN 50 MG/50ML IV SOLN",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "25021041450",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.33,
      "maximum": 197.06,
      "gross_charge": 209.64,
      "discounted_cash": 115.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 142.13592,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.3276,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 197.0616,
          "standard_charge_percentage": 94.0,
          "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": 76.812096,
          "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": 61.445484,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.3276,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "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": "No payer specific notes",
          "standard_charge_dollar": 178.194,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 186.5796,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 186.5796,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 187.6278,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 187.6278,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 119.4948,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 188.676,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 188.676,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.928746,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 197.0616,
          "standard_charge_percentage": 94.0,
          "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": 99.579,
          "standard_charge_percentage": 47.5,
          "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"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGATROBAN 50 MG/50ML IV SOLN (MULTI-GPI)",
  "drug_information": {
    "unit": 50.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65219042950",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.24,
      "maximum": 358.91,
      "gross_charge": 381.82,
      "discounted_cash": 210.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 258.87396,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.47372,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 358.9108,
          "standard_charge_percentage": 94.0,
          "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": 139.898848,
          "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": 111.911442,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.47372,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "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": "No payer specific notes",
          "standard_charge_dollar": 324.547,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 339.8198,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 339.8198,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 341.7289,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 341.7289,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 217.6374,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 343.638,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 343.638,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.47372,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 358.9108,
          "standard_charge_percentage": 94.0,
          "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": 181.3645,
          "standard_charge_percentage": 47.5,
          "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": 95.455,
          "standard_charge_percentage": 25.0,
          "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": 4.04,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.04,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.0375,
          "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": 3.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.978,
          "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": 0.99,
      "maximum": 4.04,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.98826,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.98826,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.04,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.0375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.09582,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Argatroban nonesrd (auromed)",
  "code_information": [
    {
      "code": "J0898",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.1,
      "maximum": 3.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.978,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.098279,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ARGININE 10% (FOR AMMONUL PANEL) LOADING DOSE",
  "drug_information": {
    "unit": 300.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00009043601_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 41.23,
      "maximum": 155.01,
      "gross_charge": 164.9,
      "discounted_cash": 90.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 111.8022,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 155.006,
          "standard_charge_percentage": 94.0,
          "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": 60.41936,
          "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": 48.33219,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 139.8352,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 131.92,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 140.165,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 146.761,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 146.761,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 147.5855,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 151.3782,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.993,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.41,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.41,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 155.006,
          "standard_charge_percentage": 94.0,
          "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": 78.3275,
          "standard_charge_percentage": 47.5,
          "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": 41.225,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGININE 10% (FOR AMMONUL PANEL) MAINTENANCE INFUSION",
  "drug_information": {
    "unit": 300.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00009043601_4",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 41.23,
      "maximum": 155.01,
      "gross_charge": 164.9,
      "discounted_cash": 90.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 111.8022,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 155.006,
          "standard_charge_percentage": 94.0,
          "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": 60.41936,
          "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": 48.33219,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 131.92,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 139.8352,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 140.165,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 146.761,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 146.761,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 151.3782,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 147.5855,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.993,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.41,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.41,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 155.006,
          "standard_charge_percentage": 94.0,
          "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": 78.3275,
          "standard_charge_percentage": 47.5,
          "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": 41.225,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGININE HCL (DIAGNOSTIC) 10 % IV SOLN",
  "drug_information": {
    "unit": 300.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00009043601",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.0,
      "maximum": 94.0,
      "gross_charge": 100.0,
      "discounted_cash": 55.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.8,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54.6,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 94.0,
          "standard_charge_percentage": 94.0,
          "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": 36.64,
          "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": 29.31,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 80.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54.6,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 84.8,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 85.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.0,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.0,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 91.8,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.5,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.0,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 90.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 90.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54.6,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 94.0,
          "standard_charge_percentage": 94.0,
          "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": 47.5,
          "standard_charge_percentage": 47.5,
          "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": 25.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGININE HCL 10 % (IV FOR PO)",
  "drug_information": {
    "unit": 300.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00009043601_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.0,
      "maximum": 94.0,
      "gross_charge": 100.0,
      "discounted_cash": 55.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.8,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54.6,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 94.0,
          "standard_charge_percentage": 94.0,
          "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": 29.31,
          "standard_charge_percentage": 29.31,
          "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": 36.64,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 84.8,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 80.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54.6,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 85.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.0,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.0,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.5,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 91.8,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.0,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 90.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 90.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54.6,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 94.0,
          "standard_charge_percentage": 94.0,
          "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": 47.5,
          "standard_charge_percentage": 47.5,
          "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": 25.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGININE HCL 10% IV SYRINGE (PEDS)",
  "drug_information": {
    "unit": 300.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00009043601_5",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 41.23,
      "maximum": 155.01,
      "gross_charge": 164.9,
      "discounted_cash": 90.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 111.8022,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 155.006,
          "standard_charge_percentage": 94.0,
          "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": 60.41936,
          "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": 48.33219,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 131.92,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 139.8352,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 140.165,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 146.761,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 146.761,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 147.5855,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 151.3782,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.993,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.41,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.41,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.0354,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 155.006,
          "standard_charge_percentage": 94.0,
          "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": 78.3275,
          "standard_charge_percentage": 47.5,
          "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": 41.225,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARGININE HCL 1MEQ/ML ORAL SOLUTION",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P0009043624",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.672,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "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": 2047.77,
      "maximum": 3750.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2047.773,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2047.773,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2764.49355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3750.5,
          "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": 3750.5,
          "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": 2047.77,
      "maximum": 3750.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2047.773,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2047.773,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2764.49355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3750.5,
          "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": 3750.5,
          "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": 2047.77,
      "maximum": 3750.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2047.773,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2047.773,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2764.49355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3750.5,
          "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": 3750.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 1 MG/ML PO SOLN",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "66689073505",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.13,
      "maximum": 4.26,
      "gross_charge": 4.53,
      "discounted_cash": 2.49,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.07134,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.47338,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.2582,
          "standard_charge_percentage": 94.0,
          "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": 1.659792,
          "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": 1.327743,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.84144,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.47338,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.624,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.8505,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.0317,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.0317,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.05435,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.05435,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.5821,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.077,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.077,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.47338,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.2582,
          "standard_charge_percentage": 94.0,
          "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": 2.15175,
          "standard_charge_percentage": 47.5,
          "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": 1.1325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 10 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50268008915",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 10 MG PO TBDP",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "43598073330",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.43,
      "maximum": 9.15,
      "gross_charge": 9.73,
      "discounted_cash": 5.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.59694,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.31258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.1462,
          "standard_charge_percentage": 94.0,
          "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": 3.565072,
          "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": 2.851863,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.31258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 8.25104,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7.784,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.2705,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.6597,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.6597,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.70835,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.70835,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.5461,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.757,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.757,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.31258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.1462,
          "standard_charge_percentage": 94.0,
          "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": 4.62175,
          "standard_charge_percentage": 47.5,
          "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": 2.4325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 15 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50268009012",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 15 MG PO TBDP",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "43598073430",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.43,
      "maximum": 9.15,
      "gross_charge": 9.73,
      "discounted_cash": 5.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.59694,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.31258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.1462,
          "standard_charge_percentage": 94.0,
          "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": 3.565072,
          "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": 2.851863,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.31258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 8.25104,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7.784,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.2705,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.6597,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.6597,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.70835,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.70835,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.5461,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.757,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.757,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.31258,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.1462,
          "standard_charge_percentage": 94.0,
          "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": 4.62175,
          "standard_charge_percentage": 47.5,
          "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": 2.4325,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 2 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687015721",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.78,
      "maximum": 10.43,
      "gross_charge": 11.1,
      "discounted_cash": 6.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.5258,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.0606,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.434,
          "standard_charge_percentage": 94.0,
          "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": 3.25341,
          "standard_charge_percentage": 29.31,
          "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": 4.06704,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 8.88,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.0606,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 9.4128,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.435,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.879,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.879,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.9345,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.9345,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.327,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.99,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.99,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.0606,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.434,
          "standard_charge_percentage": 94.0,
          "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": 5.2725,
          "standard_charge_percentage": 47.5,
          "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": 2.775,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 20 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687020221",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.76,
      "maximum": 14.15,
      "gross_charge": 15.05,
      "discounted_cash": 8.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.2039,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.2173,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.147,
          "standard_charge_percentage": 94.0,
          "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": 5.51432,
          "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": 4.411155,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 12.7624,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.2173,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 12.04,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.7925,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.3945,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.3945,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.46975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.46975,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.5785,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.545,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.545,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.2173,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.147,
          "standard_charge_percentage": 94.0,
          "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": 7.14875,
          "standard_charge_percentage": 47.5,
          "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": 3.7625,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 30 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687021321",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.94,
      "maximum": 14.82,
      "gross_charge": 15.77,
      "discounted_cash": 8.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.69206,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.61042,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.8238,
          "standard_charge_percentage": 94.0,
          "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": 4.622187,
          "standard_charge_percentage": 29.31,
          "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": 5.778128,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 13.37296,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 12.616,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.61042,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.4045,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.0353,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.0353,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.11415,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.11415,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.9889,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.193,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.193,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.61042,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.8238,
          "standard_charge_percentage": 94.0,
          "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": 7.49075,
          "standard_charge_percentage": 47.5,
          "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": 3.9425,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE 5 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50268008815",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE ER 300 MG IM PRSY",
  "drug_information": {
    "unit": 1.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "59148004580",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.97,
      "maximum": 5185.5,
      "gross_charge": 5516.49,
      "discounted_cash": 3034.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3740.18022,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.96942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5185.5006,
          "standard_charge_percentage": 94.0,
          "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": 2021.241936,
          "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": 1616.883219,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.96942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.4035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4689.0165,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4909.6761,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4909.6761,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4937.25855,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4937.25855,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3144.3993,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4964.841,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4964.841,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.211297,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5185.5006,
          "standard_charge_percentage": 94.0,
          "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": 2620.33275,
          "standard_charge_percentage": 47.5,
          "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": 7.27,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE ER 400 MG IM PRSY",
  "drug_information": {
    "unit": 400.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "59148007280",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.97,
      "maximum": 6914.02,
      "gross_charge": 7355.34,
      "discounted_cash": 4045.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4986.92052,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.96942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6914.0196,
          "standard_charge_percentage": 94.0,
          "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": 2155.850154,
          "standard_charge_percentage": 29.31,
          "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": 2694.996576,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.4035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.96942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6252.039,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6546.2526,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6546.2526,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6583.0293,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6583.0293,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4192.5438,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6619.806,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6619.806,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.211297,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6914.0196,
          "standard_charge_percentage": 94.0,
          "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": 3493.7865,
          "standard_charge_percentage": 47.5,
          "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": 7.27,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE ER 400 MG IM SRER",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "59148001971",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1838.84,
      "maximum": 6914.02,
      "gross_charge": 7355.34,
      "discounted_cash": 4045.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4986.92052,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4016.01564,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6914.0196,
          "standard_charge_percentage": 94.0,
          "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": 2694.996576,
          "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": 2155.850154,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 6237.32832,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4016.01564,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5884.272,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6252.039,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6546.2526,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6546.2526,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6583.0293,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6583.0293,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4192.5438,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6619.806,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6619.806,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4016.01564,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6914.0196,
          "standard_charge_percentage": 94.0,
          "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": 3493.7865,
          "standard_charge_percentage": 47.5,
          "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": 1838.835,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE LAUROXIL ER 1064 MG/3.9ML IM PRSY",
  "drug_information": {
    "unit": 3.9,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65757040403",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2531.54,
      "maximum": 9518.57,
      "gross_charge": 10126.14,
      "discounted_cash": 5569.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6865.52292,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5528.87244,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9518.5716,
          "standard_charge_percentage": 94.0,
          "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": 3710.217696,
          "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": 2967.971634,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 8586.96672,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 8100.912,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5528.87244,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8607.219,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9012.2646,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9012.2646,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9062.8953,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9062.8953,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5771.8998,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9113.526,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9113.526,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5528.87244,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9518.5716,
          "standard_charge_percentage": 94.0,
          "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": 4809.9165,
          "standard_charge_percentage": 47.5,
          "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": 2531.535,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE LAUROXIL ER 441 MG/1.6ML IM PRSY",
  "drug_information": {
    "unit": 1.6,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65757040103",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1049.25,
      "maximum": 3945.18,
      "gross_charge": 4197.0,
      "discounted_cash": 2308.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2845.566,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2291.562,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3945.18,
          "standard_charge_percentage": 94.0,
          "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": 1537.7808,
          "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": 1230.1407,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2291.562,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3357.6,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3559.056,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3567.45,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3735.33,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3735.33,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3756.315,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3756.315,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2392.29,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3777.3,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3777.3,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2291.562,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3945.18,
          "standard_charge_percentage": 94.0,
          "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": 1993.575,
          "standard_charge_percentage": 47.5,
          "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": 1049.25,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE LAUROXIL ER 662 MG/2.4ML IM PRSY",
  "drug_information": {
    "unit": 2.4,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65757040203",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1575.08,
      "maximum": 5922.28,
      "gross_charge": 6300.3,
      "discounted_cash": 3465.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4271.6034,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3439.9638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5922.282,
          "standard_charge_percentage": 94.0,
          "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": 2308.42992,
          "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": 1846.61793,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3439.9638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 5342.6544,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5040.24,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5355.255,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5607.267,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5607.267,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5638.7685,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5638.7685,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3591.171,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5670.27,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5670.27,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3439.9638,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5922.282,
          "standard_charge_percentage": 94.0,
          "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": 2992.6425,
          "standard_charge_percentage": 47.5,
          "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": 1575.075,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE LAUROXIL ER 675 MG/2.4ML IM PRSY",
  "drug_information": {
    "unit": 2.4,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65757050003",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1606.0,
      "maximum": 6038.55,
      "gross_charge": 6423.99,
      "discounted_cash": 3533.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4355.46522,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3507.49854,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6038.5506,
          "standard_charge_percentage": 94.0,
          "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": 1882.871469,
          "standard_charge_percentage": 29.31,
          "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": 2353.749936,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3507.49854,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5139.192,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 5447.54352,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5460.3915,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5717.3511,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5717.3511,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5749.47105,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5749.47105,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3661.6743,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5781.591,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5781.591,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3507.49854,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6038.5506,
          "standard_charge_percentage": 94.0,
          "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": 3051.39525,
          "standard_charge_percentage": 47.5,
          "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": 1605.9975,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARIPIPRAZOLE LAUROXIL ER 882 MG/3.2ML IM PRSY",
  "drug_information": {
    "unit": 3.2,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65757040303",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.82,
      "maximum": 7890.33,
      "gross_charge": 8393.97,
      "discounted_cash": 4616.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5691.11166,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.82364,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7890.3318,
          "standard_charge_percentage": 94.0,
          "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": 3075.550608,
          "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": 2460.272607,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.82364,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "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": "No payer specific notes",
          "standard_charge_dollar": 7134.8745,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7470.6333,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7470.6333,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7512.60315,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7512.60315,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4784.5629,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7554.573,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7554.573,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.380833,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7890.3318,
          "standard_charge_percentage": 94.0,
          "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": 3987.13575,
          "standard_charge_percentage": 47.5,
          "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": 3.34,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARMODAFINIL 150 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "63459021530",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.64,
      "maximum": 77.59,
      "gross_charge": 82.54,
      "discounted_cash": 45.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.96212,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.06684,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 77.5876,
          "standard_charge_percentage": 94.0,
          "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": 30.242656,
          "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": 24.192474,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.06684,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 66.032,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 69.99392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 70.159,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.4606,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.4606,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.8733,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.8733,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.0478,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.286,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.286,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.06684,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.5876,
          "standard_charge_percentage": 94.0,
          "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": 39.2065,
          "standard_charge_percentage": 47.5,
          "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": 20.635,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARMODAFINIL 250 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "63459022530",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.64,
      "maximum": 77.59,
      "gross_charge": 82.54,
      "discounted_cash": 45.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.96212,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.06684,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 77.5876,
          "standard_charge_percentage": 94.0,
          "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": 30.242656,
          "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": 24.192474,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 69.99392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 66.032,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.06684,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 70.159,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.4606,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.4606,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.8733,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.8733,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.0478,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.286,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.286,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.06684,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.5876,
          "standard_charge_percentage": 94.0,
          "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": 39.2065,
          "standard_charge_percentage": 47.5,
          "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": 20.635,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARMODAFINIL 50 MG PO TABS",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R6345920530",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.77,
      "maximum": 44.26,
      "gross_charge": 47.09,
      "discounted_cash": 25.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.92702,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.71114,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 44.2646,
          "standard_charge_percentage": 94.0,
          "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": 17.253776,
          "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": 13.802079,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 37.672,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 39.93232,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.71114,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.0265,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.9101,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.9101,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.14555,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.14555,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.8413,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.381,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.381,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.71114,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.2646,
          "standard_charge_percentage": 94.0,
          "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": 22.36775,
          "standard_charge_percentage": 47.5,
          "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": 11.7725,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARSENIC TRIOXIDE 10 MG/10ML IV SOLN",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68382099710",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.31,
      "maximum": 104.54,
      "gross_charge": 111.21,
      "discounted_cash": 61.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 75.40038,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.72066,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 104.5374,
          "standard_charge_percentage": 94.0,
          "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": 32.595651,
          "standard_charge_percentage": 29.31,
          "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": 40.747344,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.72066,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": "No payer specific notes",
          "standard_charge_dollar": 94.5285,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.9769,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.9769,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.53295,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.53295,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.3897,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.089,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.089,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.30712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 104.5374,
          "standard_charge_percentage": 94.0,
          "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": 52.82475,
          "standard_charge_percentage": 47.5,
          "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": 27.8025,
          "standard_charge_percentage": 25.0,
          "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": 16.13,
      "maximum": 29.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1343,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.051579,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.55,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artacent cord per sq cm",
  "code_information": [
    {
      "code": "Q4216",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artecent c, per sq cm",
  "code_information": [
    {
      "code": "Q4336",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTEMETHER-LUMEFANTRINE 20-120 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00078056845",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.18,
      "maximum": 11.96,
      "gross_charge": 12.72,
      "discounted_cash": 7.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.62416,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.94512,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.9568,
          "standard_charge_percentage": 94.0,
          "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": 4.660608,
          "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": 3.728232,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.94512,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 10.176,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 10.78656,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.812,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.3208,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.3208,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.3844,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.3844,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.2504,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.448,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.448,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.94512,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.9568,
          "standard_charge_percentage": 94.0,
          "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": 6.042,
          "standard_charge_percentage": 47.5,
          "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": 3.18,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARTERY X-RAYS ABDOMEN",
  "code_information": [
    {
      "code": "75726",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3104.02,
      "maximum": 5685.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3984.54147,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "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": 1761.33,
      "maximum": 3225.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2320.02225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3225.87,
          "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": 3225.87,
          "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": 1761.33,
      "maximum": 3225.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2320.02225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3225.87,
          "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": 3225.87,
          "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": 1761.33,
      "maximum": 3225.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2320.02225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3225.87,
          "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": 3225.87,
          "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": 1761.33,
      "maximum": 3225.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2320.02225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3225.87,
          "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": 3225.87,
          "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": 1761.33,
      "maximum": 3225.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2320.02225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3225.87,
          "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": 3225.87,
          "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": 1761.33,
      "maximum": 3225.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2320.02225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3225.87,
          "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": 3225.87,
          "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": 1761.33,
      "maximum": 3225.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1761.32502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2320.02225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3225.87,
          "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": 3225.87,
          "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": 3104.02,
      "maximum": 5685.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3984.54147,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "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": 3104.02,
      "maximum": 5685.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3984.54147,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "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": 3104.02,
      "maximum": 5685.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3984.54147,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "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": 3104.02,
      "maximum": 5685.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3104.01546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3984.54147,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.01,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTESUNATE 110 MG IV SOLR",
  "drug_information": {
    "unit": 11.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "73607001111",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3382.79,
      "maximum": 12719.3,
      "gross_charge": 13531.17,
      "discounted_cash": 7442.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9174.13326,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7388.01882,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12719.2998,
          "standard_charge_percentage": 94.0,
          "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": 3965.985927,
          "standard_charge_percentage": 29.31,
          "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": 4957.820688,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 11474.43216,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 10824.936,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7388.01882,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11501.4945,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12042.7413,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12042.7413,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12110.39715,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12110.39715,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7712.7669,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12178.053,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12178.053,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7388.01882,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12719.2998,
          "standard_charge_percentage": 94.0,
          "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": 6427.30575,
          "standard_charge_percentage": 47.5,
          "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": 3382.7925,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARTHR ANK OSTCHN DF TAL&/TIB",
  "code_information": [
    {
      "code": "29891",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 15136.06,
      "maximum": 27721.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15136.06458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15136.06458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27721.73,
          "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": 27721.73,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT TORAL/XORAL C1-C2",
  "code_information": [
    {
      "code": "22548",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 13555.31,
      "maximum": 27721.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15136.06458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15136.06458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27721.73,
          "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": 27721.73,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 13555.31,
      "maximum": 27721.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15136.06458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15136.06458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27721.73,
          "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": 27721.73,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS PANTALAR",
  "code_information": [
    {
      "code": "28705",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS SUBTALAR",
  "code_information": [
    {
      "code": "28725",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS TRIPLE",
  "code_information": [
    {
      "code": "28715",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Arthroflex",
  "code_information": [
    {
      "code": "Q4125",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 9780.82,
      "maximum": 17913.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9780.82014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13555.305855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17913.59,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 7161.75,
      "maximum": 13116.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7161.75096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9484.133022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13116.76,
          "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": 13116.76,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "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": 1825.21,
      "maximum": 3342.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1825.20702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2391.602031,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3342.87,
          "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": 3342.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTIFICIAL INSEMINATION",
  "code_information": [
    {
      "code": "58321",
      "type": "HCPCS"
    },
    {
      "code": "58322",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 112.78,
      "maximum": 311.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 169.98618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112.7763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 169.98618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112.7763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 224.218449,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 148.282407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 311.33,
          "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": 206.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 311.33,
          "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": 206.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTIFICIAL TEARS 83-15 % OP OINT",
  "drug_information": {
    "unit": 4.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "63736014308",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "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": 77.79,
      "maximum": 142.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 77.78862,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 77.78862,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 101.977785,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASAY OF INTERLEUKIN-6 (IL-6)",
  "code_information": [
    {
      "code": "83529",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.43,
      "maximum": 17.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.42942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.42942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.729717,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 69.42,
      "maximum": 127.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.41844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASCORBIC ACID 25000 MG/50ML IV SOLN",
  "drug_information": {
    "unit": 0.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "67157010150",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASCORBIC ACID 500 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00904052361",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "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": 56.67,
      "maximum": 103.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.18175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103.79,
          "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": 103.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASENAPINE MALEATE 5 MG SL SUBL",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "42794001610",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.67,
      "maximum": 6.27,
      "gross_charge": 6.67,
      "discounted_cash": 3.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.52226,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.64182,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.2698,
          "standard_charge_percentage": 94.0,
          "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": 2.443888,
          "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": 1.954977,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 5.65616,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.64182,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5.336,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.6695,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.9363,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.9363,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.96965,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.96965,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.8019,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.003,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.003,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.64182,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.2698,
          "standard_charge_percentage": 94.0,
          "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": 3.16825,
          "standard_charge_percentage": 47.5,
          "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": 1.6675,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASHKENAZI JEWISH ASSOC DIS",
  "code_information": [
    {
      "code": "81412",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1336.91,
      "maximum": 2448.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1336.91376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1336.91376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1804.833576,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASPA GENE",
  "code_information": [
    {
      "code": "81200",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.8,
      "maximum": 47.25,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.7985,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.7985,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.827975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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 ERWINIA CHRY-RYWN 10 MG/0.5ML IM SOLN",
  "drug_information": {
    "unit": 0.5,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68727090003",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3735.0,
      "maximum": 14043.6,
      "gross_charge": 14940.0,
      "discounted_cash": 8217.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10129.32,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8157.24,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14043.6,
          "standard_charge_percentage": 94.0,
          "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": 4378.914,
          "standard_charge_percentage": 29.31,
          "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": 5474.016,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 12669.12,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 11952.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8157.24,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12699.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13296.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13296.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13371.3,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13371.3,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8515.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13446.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13446.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8157.24,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14043.6,
          "standard_charge_percentage": 94.0,
          "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": 7096.5,
          "standard_charge_percentage": 47.5,
          "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": 3735.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPERGILLUS AG IA",
  "code_information": [
    {
      "code": "87305",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.54,
      "maximum": 11.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.54108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.54108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.830458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 8.22,
      "maximum": 15.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.2173,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.2173,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.093355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": 395.01,
      "maximum": 723.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.01462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.01462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.616189,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 723.47,
          "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": 723.47,
          "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": 349.93,
      "maximum": 640.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 349.92594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 349.92594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 455.719446,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 640.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 640.89,
          "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": 349.93,
      "maximum": 640.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 349.92594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 349.92594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 455.719446,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 640.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 640.89,
          "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": 171.23,
      "maximum": 313.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.2256,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.2256,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 217.584549,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 313.6,
          "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": 313.6,
          "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": 1326.22,
      "maximum": 2428.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1326.22308,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1326.22308,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1719.624816,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2428.98,
          "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": 2428.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASPIRIN 0.1 MG/ML FOR DESENSITIZATION",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "C6373943401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 1 MG/ML FOR DESENSITIZATION",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "C6373943401_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 10 MG/ML ORAL SUSPENSION",
  "drug_information": {
    "unit": 8.1,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252000057",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 300 MG RE SUPP",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00574703412",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 325 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "66553000101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 325 MG PO TBEC",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "1013512601",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 8.1 MG/ML ORAL SUSPENSION",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "08252000056",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.24,
      "maximum": 106.17,
      "gross_charge": 112.95,
      "discounted_cash": 62.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.5801,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 61.6707,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 106.173,
          "standard_charge_percentage": 94.0,
          "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": 41.38488,
          "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": 33.105645,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 95.7816,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 61.6707,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 90.36,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 96.0075,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.5255,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.5255,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.09025,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.09025,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 64.3815,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.655,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.655,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 61.6707,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 106.173,
          "standard_charge_percentage": 94.0,
          "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": 53.65125,
          "standard_charge_percentage": 47.5,
          "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": 28.2375,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 80 MG SUPPOSITORY",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P0904404073",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.672,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 80 MG SUPPOSITORY (NICU)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P0904404073_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.672,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 81 MG PO CHEW",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "66553000201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 81 MG PO CHEW (NICU)",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "66553000201_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN 81 MG PO TBEC",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R7139986271",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65162059606",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASSAY 17- KETOSTEROIDS",
  "code_information": [
    {
      "code": "83586",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.99,
      "maximum": 12.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.9888,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.9888,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.43488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY ACID PHOSPHATASE",
  "code_information": [
    {
      "code": "84060",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.17,
      "maximum": 7.64,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.17144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.17144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.631444,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.64,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY ACTIVATED PROTEIN C",
  "code_information": [
    {
      "code": "85307",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.36,
      "maximum": 15.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.36472,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.36472,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.292372,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.32,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY ALKALINE PHOSPHATASE",
  "code_information": [
    {
      "code": "84075",
      "type": "HCPCS"
    },
    {
      "code": "84078",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.83,
      "maximum": 8.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.82828,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.50996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.82828,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.50996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.818178,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.088446,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.18,
          "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": 8.26,
          "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": 5.18,
          "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": 8.26,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY ALKALINE PHOSPHATASES",
  "code_information": [
    {
      "code": "84080",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.07,
      "maximum": 14.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.06988,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.06988,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.894338,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.78,
          "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": 14.78,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY AMINOLEVULINIC ACID",
  "code_information": [
    {
      "code": "82135",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.98,
      "maximum": 16.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.9817,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.9817,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.125295,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.45,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY ANTI-MULLERIAN HORM",
  "code_information": [
    {
      "code": "82166",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 21.09,
      "maximum": 38.62,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.08652,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.08652,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.466802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.62,
          "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": 38.62,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY BLD/SERUM CHOLESTEROL",
  "code_information": [
    {
      "code": "82465",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.38,
      "maximum": 4.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.3751,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.3751,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.206385,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.35,
          "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": 4.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY BLOOD CARBON DIOXIDE",
  "code_information": [
    {
      "code": "82374",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.66,
      "maximum": 4.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.66448,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.66448,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.597048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.88,
          "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": 4.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY BLOOD CATECHOLAMINES",
  "code_information": [
    {
      "code": "82383",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.88,
      "maximum": 29.08,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.87768,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.87768,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.434868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.08,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY C-D TRANSFER MEASURE",
  "code_information": [
    {
      "code": "82373",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.86,
      "maximum": 18.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.86076,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.86076,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.312026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY CARBAMAZEPINE FREE",
  "code_information": [
    {
      "code": "80157",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.23,
      "maximum": 13.25,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.2345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.2345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.766575,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.25,
          "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": 13.25,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY CARBAMAZEPINE TOTAL",
  "code_information": [
    {
      "code": "80156",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.96,
      "maximum": 14.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.95522,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.95522,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.739547,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.57,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.57,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY CARBOXYHB QUAL",
  "code_information": [
    {
      "code": "82376",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.68,
      "maximum": 14.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.68222,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.68222,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.370997,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.07,
          "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": 14.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY CARBOXYHB QUANT",
  "code_information": [
    {
      "code": "82375",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.73,
      "maximum": 12.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.72672,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.72672,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.081072,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.32,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY CHONDROITIN SULFATE",
  "code_information": [
    {
      "code": "82485",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.27,
      "maximum": 20.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.2749,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.2749,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.221115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.65,
          "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": 20.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY DIPROPYLACETIC ACD TOT",
  "code_information": [
    {
      "code": "80164",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.39,
      "maximum": 13.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.39284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.39284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.980334,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY DIR MEAS FR ESTRADIOL",
  "code_information": [
    {
      "code": "82681",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.26,
      "maximum": 27.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.25524,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.25524,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.594574,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.94,
          "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": 27.94,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY DUODENAL FLUID TRYPSIN",
  "code_information": [
    {
      "code": "84485",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.93,
      "maximum": 7.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.9312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.9312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.30712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY FOR CALPROTECTIN FECAL",
  "code_information": [
    {
      "code": "83993",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.72,
      "maximum": 19.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.71798,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.71798,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.469273,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.63,
          "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": 19.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY FREE HYDROXYPROLINE",
  "code_information": [
    {
      "code": "83500",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.37,
      "maximum": 22.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.3669,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.3669,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.695315,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.65,
          "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": 22.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY GALACTOSE TRANSFERASE",
  "code_information": [
    {
      "code": "82775",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.5,
      "maximum": 21.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.50422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.50422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.530697,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.07,
          "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": 21.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY GLUCOSE BLOOD QUANT",
  "code_information": [
    {
      "code": "82947",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.15,
      "maximum": 3.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.14578,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.14578,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.896803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.93,
          "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": 3.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY GROWTH HORMONE (HGH)",
  "code_information": [
    {
      "code": "83003",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.1,
      "maximum": 16.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.10182,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.10182,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.287457,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.67,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY IGA/IGD/IGG/IGM EACH",
  "code_information": [
    {
      "code": "82784",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.08,
      "maximum": 9.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.0778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.0778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.85503,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.3,
          "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": 9.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY LIPOPROTEIN PLA2",
  "code_information": [
    {
      "code": "83698",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.29,
      "maximum": 46.31,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.28526,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.28526,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.135101,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.31,
          "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": 46.31,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY MALATE DEHYDROGENASE",
  "code_information": [
    {
      "code": "83775",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.02,
      "maximum": 7.37,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.02402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.02402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.432427,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.37,
          "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": 7.37,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY MYELOPEROXIDASE",
  "code_information": [
    {
      "code": "83876",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.77,
      "maximum": 50.86,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.76956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.76956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.488906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.86,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY NEPHELOMETRY NOT SPEC",
  "code_information": [
    {
      "code": "83883",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.43,
      "maximum": 13.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.4256,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.4256,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.02456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.6,
          "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": 13.6,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY NEURFLMNT LIGHT CHAIN",
  "code_information": [
    {
      "code": "83884",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.46,
      "maximum": 116.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 63.46158,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 63.46158,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.23,
          "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": 116.23,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY NONENDOCRINE RECEPTOR",
  "code_information": [
    {
      "code": "84238",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.97,
      "maximum": 36.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.96722,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.96722,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.955747,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.57,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.57,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF 17-HYDROXYPREGNENO",
  "code_information": [
    {
      "code": "84143",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.45,
      "maximum": 22.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.45426,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.45426,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.813251,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.81,
          "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": 22.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF 5-HIAA",
  "code_information": [
    {
      "code": "83497",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.04,
      "maximum": 12.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.0434,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.0434,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.50859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.9,
          "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": 12.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ACTH",
  "code_information": [
    {
      "code": "82024",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 21.09,
      "maximum": 38.62,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.08652,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.08652,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.466802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.62,
          "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": 38.62,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ADP & AMP",
  "code_information": [
    {
      "code": "82030",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.09,
      "maximum": 25.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.0868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.0868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.01718,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ALDOLASE",
  "code_information": [
    {
      "code": "82085",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.3,
      "maximum": 9.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.30166,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.30166,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.157241,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.71,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ALDOSTERONE",
  "code_information": [
    {
      "code": "82088",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22.25,
      "maximum": 40.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.2495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.2495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.036825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.75,
          "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": 40.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ALUMINUM",
  "code_information": [
    {
      "code": "82108",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.91,
      "maximum": 25.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.91208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.91208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.781308,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF AMIKACIN",
  "code_information": [
    {
      "code": "80150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.23,
      "maximum": 15.08,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.23368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.23368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.115468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.08,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF AMMONIA",
  "code_information": [
    {
      "code": "82140",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.96,
      "maximum": 14.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.95522,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.95522,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.739547,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.57,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.57,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF AMYLASE",
  "code_information": [
    {
      "code": "82150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.54,
      "maximum": 6.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.776408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ANDROSTENEDIONE",
  "code_information": [
    {
      "code": "82157",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.99,
      "maximum": 29.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.98688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.98688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.582288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.28,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ANDROSTERONE",
  "code_information": [
    {
      "code": "82160",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.95,
      "maximum": 25.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.9503,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.9503,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.832905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ANGIOTENSIN II",
  "code_information": [
    {
      "code": "82163",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.2,
      "maximum": 20.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.20392,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.20392,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.125292,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF APOLIPOPROTEIN",
  "code_information": [
    {
      "code": "82172",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.52,
      "maximum": 21.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.51514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.51514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.545439,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.09,
          "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": 21.09,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ARSENIC",
  "code_information": [
    {
      "code": "82175",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.36,
      "maximum": 18.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.35762,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.35762,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.982787,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.97,
          "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": 18.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ASCORBIC ACID",
  "code_information": [
    {
      "code": "82180",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.4,
      "maximum": 9.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.39994,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.39994,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.289919,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.89,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF B HEXOSAMINIDASE EA",
  "code_information": [
    {
      "code": "83080",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.21,
      "maximum": 16.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.434877,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY OF BETA-2 PROTEIN",
  "code_information": [
    {
      "code": "82232",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.83,
      "maximum": 16.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.83428,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.83428,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.926278,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.18,
          "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": 16.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF BIOTINIDASE",
  "code_information": [
    {
      "code": "82261",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.21,
      "maximum": 16.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.434877,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY OF BLOOD CHLORIDE",
  "code_information": [
    {
      "code": "82435",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.51,
      "maximum": 4.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.5116,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.5116,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.39066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF BLOOD FATTY ACIDS",
  "code_information": [
    {
      "code": "82725",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.25,
      "maximum": 18.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.24842,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.24842,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.835367,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.77,
          "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": 18.77,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF BLOOD LIPOPROTEIN",
  "code_information": [
    {
      "code": "83719",
      "type": "HCPCS"
    },
    {
      "code": "83721",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.73,
      "maximum": 12.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.9615,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.733,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.9615,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.733,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.398025,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.73955,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.5,
          "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": 12.75,
          "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": 10.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF BLOOD OSMOLALITY",
  "code_information": [
    {
      "code": "83930",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.61,
      "maximum": 6.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.60906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.60906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.872231,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.61,
          "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": 6.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF BLOOD PKU",
  "code_information": [
    {
      "code": "84030",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.0,
      "maximum": 5.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.003,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.003,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.05405,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.5,
          "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": 5.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF BLOOD/URIC ACID",
  "code_information": [
    {
      "code": "84550",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.47,
      "maximum": 4.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.46792,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.46792,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.331692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF BRADYKININ",
  "code_information": [
    {
      "code": "82286",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.82,
      "maximum": 5.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.81736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.81736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.803436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.16,
          "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": 5.16,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF BREATH ETHANOL",
  "code_information": [
    {
      "code": "82075",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.38,
      "maximum": 30.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.0,
          "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": 30.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF C-PEPTIDE",
  "code_information": [
    {
      "code": "84681",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.36,
      "maximum": 20.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.36226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.36226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.339051,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.81,
          "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": 20.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CADMIUM",
  "code_information": [
    {
      "code": "82300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.91,
      "maximum": 23.64,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.90744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.90744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.425044,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.64,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CALCITONIN",
  "code_information": [
    {
      "code": "82308",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.63,
      "maximum": 26.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.62734,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.62734,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.746909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.79,
          "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": 26.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CALCIUM",
  "code_information": [
    {
      "code": "82310",
      "type": "HCPCS"
    },
    {
      "code": "82330",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.82,
      "maximum": 13.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.81736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.46928,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.81736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.46928,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.803436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.083528,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.16,
          "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": 13.68,
          "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": 5.16,
          "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": 13.68,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CALCIUM IN URINE",
  "code_information": [
    {
      "code": "82340",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.29,
      "maximum": 6.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.29238,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.29238,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.444713,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.03,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.03,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CARNITINE",
  "code_information": [
    {
      "code": "82379",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.21,
      "maximum": 16.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.21102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.434877,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY OF CAROTENE",
  "code_information": [
    {
      "code": "82380",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.03,
      "maximum": 9.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.03412,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.03412,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.796062,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.22,
          "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": 9.22,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CATHEPSIN-D",
  "code_information": [
    {
      "code": "82387",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.86,
      "maximum": 18.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.86076,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.86076,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.312026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CERULOPLASMIN",
  "code_information": [
    {
      "code": "82390",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.86,
      "maximum": 10.74,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.86404,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.86404,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.916454,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.74,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CHLORAMPHENICOL",
  "code_information": [
    {
      "code": "82415",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.92,
      "maximum": 12.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.91782,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.91782,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.339057,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.67,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CHROMIUM",
  "code_information": [
    {
      "code": "82495",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.07,
      "maximum": 20.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.07288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.07288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.948388,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.28,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CITRATE",
  "code_information": [
    {
      "code": "82507",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.18,
      "maximum": 27.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.1788,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.1788,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.49138,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CK (CPK)",
  "code_information": [
    {
      "code": "82550",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.55,
      "maximum": 6.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.55446,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.55446,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.798521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF COPPER",
  "code_information": [
    {
      "code": "82525",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.78,
      "maximum": 12.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.77586,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.77586,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.147411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.41,
          "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": 12.41,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CORTICOSTERONE",
  "code_information": [
    {
      "code": "82528",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.3,
      "maximum": 22.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.599492,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CPK IN BLOOD",
  "code_information": [
    {
      "code": "82552",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.31,
      "maximum": 13.39,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.31094,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.31094,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.869769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.39,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CREATINE",
  "code_information": [
    {
      "code": "82540",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.53,
      "maximum": 4.64,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.53344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.53344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.420144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.64,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CREATININE",
  "code_information": [
    {
      "code": "82565",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.8,
      "maximum": 5.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.79552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.79552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.773952,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.12,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.12,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CRYOFIBRINOGEN",
  "code_information": [
    {
      "code": "82585",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.72,
      "maximum": 14.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.72044,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.72044,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.422594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CRYOGLOBULIN",
  "code_information": [
    {
      "code": "82595",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.53,
      "maximum": 6.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.769037,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.47,
          "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": 6.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CSF PROTEIN",
  "code_information": [
    {
      "code": "83873",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.39,
      "maximum": 17.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.3912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.3912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.67812,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.2,
          "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": 17.2,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF CYANIDE",
  "code_information": [
    {
      "code": "82600",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.59,
      "maximum": 19.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.5924,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.5924,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.29974,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.4,
          "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": 19.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF DIBUCAINE NUMBER",
  "code_information": [
    {
      "code": "82638",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.69,
      "maximum": 12.25,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.6885,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.6885,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.029475,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.25,
          "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": 12.25,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF DIGOXIN FREE",
  "code_information": [
    {
      "code": "80163",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.25,
      "maximum": 13.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.25088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.25088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.788688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.28,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF DIGOXIN TOTAL",
  "code_information": [
    {
      "code": "80162",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.25,
      "maximum": 13.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.25088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.25088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.788688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.28,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ENDOCRINE HORMONE",
  "code_information": [
    {
      "code": "84235",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 38.89,
      "maximum": 71.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.89158,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.89158,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.503633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.23,
          "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": 71.23,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ERYTHROPOIETIN",
  "code_information": [
    {
      "code": "82668",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.26,
      "maximum": 18.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.25934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.25934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.850109,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.79,
          "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": 18.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ESTRIOL",
  "code_information": [
    {
      "code": "82677",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.2,
      "maximum": 24.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.20228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.20228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.823078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.18,
          "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": 24.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ESTROGEN",
  "code_information": [
    {
      "code": "82672",
      "type": "HCPCS"
    },
    {
      "code": "84233",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.85,
      "maximum": 87.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.8482,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.98248,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.8482,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.98248,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.99507,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.776348,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.7,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 87.88,
          "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": 21.7,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 87.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ESTROGENS",
  "code_information": [
    {
      "code": "82671",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17.64,
      "maximum": 32.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.6358,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.6358,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.80833,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.3,
          "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": 32.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ESTRONE",
  "code_information": [
    {
      "code": "82679",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.62,
      "maximum": 24.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.6227,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.6227,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.390645,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.95,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.95,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ETHOSUXIMIDE",
  "code_information": [
    {
      "code": "80168",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.92,
      "maximum": 16.34,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.92164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.92164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.044214,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.34,
          "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": 16.34,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ETHYLENE GLYCOL",
  "code_information": [
    {
      "code": "82693",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.14,
      "maximum": 14.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.1354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.1354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.98279,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.9,
          "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": 14.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ETIOCHOLANOLONE",
  "code_information": [
    {
      "code": "82696",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.33,
      "maximum": 26.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.32704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.32704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.341504,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FECAL FAT",
  "code_information": [
    {
      "code": "82715",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.54,
      "maximum": 22.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.54162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.54162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.931187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.97,
          "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": 22.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FECES FOR TRYPSIN",
  "code_information": [
    {
      "code": "84490",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.42,
      "maximum": 9.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.42178,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.42178,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.319403,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.93,
          "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": 9.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FECES PORPHYRINS",
  "code_information": [
    {
      "code": "84126",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 21.35,
      "maximum": 39.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.35406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.35406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.827981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.11,
          "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": 39.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FECES/UROBILINOGEN",
  "code_information": [
    {
      "code": "84577",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.17,
      "maximum": 16.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.1728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.1728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.38328,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FERRITIN",
  "code_information": [
    {
      "code": "82728",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.44,
      "maximum": 13.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.44198,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.44198,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.046673,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.63,
          "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": 13.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FETAL FIBRONECTIN",
  "code_information": [
    {
      "code": "82731",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 35.17,
      "maximum": 64.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.16786,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.16786,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.476611,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY OF FLUORIDE",
  "code_information": [
    {
      "code": "82735",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.12,
      "maximum": 18.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.12284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.12284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.665834,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FOLIC ACID RBC",
  "code_information": [
    {
      "code": "82747",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.64,
      "maximum": 17.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.6369,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.6369,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.009815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.65,
          "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": 17.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FOLIC ACID SERUM",
  "code_information": [
    {
      "code": "82746",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.03,
      "maximum": 14.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.0262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.0262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.83537,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.7,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.7,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FREE TESTOSTERONE",
  "code_information": [
    {
      "code": "84402",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.91,
      "maximum": 25.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.90662,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.90662,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.773937,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.47,
          "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": 25.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF FREE THYROXINE",
  "code_information": [
    {
      "code": "84439",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.92,
      "maximum": 9.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.92492,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.92492,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.648642,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.02,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF G6PD ENZYME",
  "code_information": [
    {
      "code": "82955",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.3,
      "maximum": 9.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.2962,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.2962,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.14987,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.7,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.7,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GALACTOSE",
  "code_information": [
    {
      "code": "82760",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.12,
      "maximum": 11.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.1152,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.1152,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.25552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.2,
          "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": 11.2,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GASTRIN",
  "code_information": [
    {
      "code": "82941",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.63,
      "maximum": 17.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.62598,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.62598,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.995073,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.63,
          "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": 17.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GDH ENZYME",
  "code_information": [
    {
      "code": "82965",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.18,
      "maximum": 13.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.1799,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.1799,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.692865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GENTAMICIN",
  "code_information": [
    {
      "code": "80170",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.94,
      "maximum": 16.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.94348,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.94348,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.073698,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.38,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GGT",
  "code_information": [
    {
      "code": "82977",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.93,
      "maximum": 7.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.9312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.9312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.30712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GLUCAGON",
  "code_information": [
    {
      "code": "82943",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.8,
      "maximum": 14.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.80234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.80234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.533159,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.29,
          "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": 14.29,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GLUCOSIDASE",
  "code_information": [
    {
      "code": "82963",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.73,
      "maximum": 21.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.72808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.72808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.832908,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GLUTATHIONE",
  "code_information": [
    {
      "code": "82978",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.44,
      "maximum": 15.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.4357,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.4357,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.388195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.45,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GLYCATED PROTEIN",
  "code_information": [
    {
      "code": "82985",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.15,
      "maximum": 16.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.15096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.15096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.353796,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.76,
          "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": 16.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GONADOTROPIN (FSH)",
  "code_information": [
    {
      "code": "83001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.14,
      "maximum": 18.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.14468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.14468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.695318,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.58,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF GONADOTROPIN (LH)",
  "code_information": [
    {
      "code": "83002",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.11,
      "maximum": 18.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.11192,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.11192,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.651092,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF HALOPERIDOL",
  "code_information": [
    {
      "code": "80173",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.62,
      "maximum": 15.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.61588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.61588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.631438,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.78,
          "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": 15.78,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF HAPTOGLOBIN QUANT",
  "code_information": [
    {
      "code": "83010",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.87,
      "maximum": 12.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.86868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.86868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.272718,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.58,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF HAPTOGLOBINS",
  "code_information": [
    {
      "code": "83012",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.68,
      "maximum": 26.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.68194,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.68194,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.820619,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.89,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF HEMOSIDERIN QUAL",
  "code_information": [
    {
      "code": "83070",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.59,
      "maximum": 4.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.5935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.5935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.501225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.75,
          "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": 4.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF HISTAMINE",
  "code_information": [
    {
      "code": "83088",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.12,
      "maximum": 29.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.12338,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.12338,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.766563,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.53,
          "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": 29.53,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF HOMOCYSTEINE",
  "code_information": [
    {
      "code": "83090",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.78,
      "maximum": 17.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.78432,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.78432,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.208832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.92,
          "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": 17.92,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF HOMOVANILLIC ACID",
  "code_information": [
    {
      "code": "83150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.24,
      "maximum": 22.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.23586,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.23586,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.518411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.41,
          "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": 22.41,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF IDH ENZYME",
  "code_information": [
    {
      "code": "83570",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.83,
      "maximum": 8.85,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.8321,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.8321,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.523335,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.85,
          "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": 8.85,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF IGE",
  "code_information": [
    {
      "code": "82785",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.99,
      "maximum": 16.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.98716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.98716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.132666,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.46,
          "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": 16.46,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF INSULIN",
  "code_information": [
    {
      "code": "83525",
      "type": "HCPCS"
    },
    {
      "code": "83527",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.24,
      "maximum": 12.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.24078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.0707,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.24078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.0707,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.425053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.545445,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.43,
          "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": 12.95,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.43,
          "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": 12.95,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF INTRINSIC FACTOR",
  "code_information": [
    {
      "code": "83528",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.82,
      "maximum": 19.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.82172,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.82172,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.609322,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.82,
          "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": 19.82,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF IRON",
  "code_information": [
    {
      "code": "83540",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.53,
      "maximum": 6.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.769037,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.47,
          "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": 6.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF KETOGENIC STEROIDS",
  "code_information": [
    {
      "code": "83582",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.45,
      "maximum": 15.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.44662,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.44662,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.402937,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.47,
          "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": 15.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LACTIC ACID",
  "code_information": [
    {
      "code": "83605",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.32,
      "maximum": 11.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.31722,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.31722,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.528247,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.57,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.57,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LAP ENZYME",
  "code_information": [
    {
      "code": "83670",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.36,
      "maximum": 9.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.35626,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.35626,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.230951,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.81,
          "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": 9.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LDH ENZYMES",
  "code_information": [
    {
      "code": "83625",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.98,
      "maximum": 12.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98334,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98334,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.427509,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.79,
          "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": 12.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LEAD",
  "code_information": [
    {
      "code": "83655",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.61,
      "maximum": 12.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.61206,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.61206,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.926281,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.11,
          "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": 12.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LIDOCAINE",
  "code_information": [
    {
      "code": "80176",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.02,
      "maximum": 14.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.02074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.02074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.827999,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.69,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.69,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LIPASE",
  "code_information": [
    {
      "code": "83690",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.76,
      "maximum": 6.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.76194,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.76194,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.078619,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.89,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LIPOPROTEIN",
  "code_information": [
    {
      "code": "83718",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.47,
      "maximum": 8.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.47174,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.47174,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.036849,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.19,
          "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": 8.19,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LIPOPROTEIN(A)",
  "code_information": [
    {
      "code": "83695",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.82,
      "maximum": 14.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.81872,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.81872,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.555272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.32,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LITHIUM",
  "code_information": [
    {
      "code": "80178",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.61,
      "maximum": 6.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.60906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.60906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.872231,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.61,
          "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": 6.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF LRH HORMONE",
  "code_information": [
    {
      "code": "83727",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.39,
      "maximum": 17.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.38574,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.38574,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.670749,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.19,
          "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": 17.19,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF MAGNESIUM",
  "code_information": [
    {
      "code": "83735",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.66,
      "maximum": 6.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.6582,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.6582,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.93857,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.7,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.7,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF MANGANESE",
  "code_information": [
    {
      "code": "83785",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.55,
      "maximum": 26.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.5509,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.5509,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.643715,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.65,
          "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": 26.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF MERCURY",
  "code_information": [
    {
      "code": "83825",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.88,
      "maximum": 16.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.87796,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.87796,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.985246,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.26,
          "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": 16.26,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF METANEPHRINES",
  "code_information": [
    {
      "code": "83835",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.25,
      "maximum": 16.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.24924,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.24924,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.486474,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.94,
          "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": 16.94,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF METHEMALBUMIN",
  "code_information": [
    {
      "code": "83857",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.86,
      "maximum": 10.74,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.86404,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.86404,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.916454,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.74,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF MYOGLOBIN",
  "code_information": [
    {
      "code": "83874",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.05,
      "maximum": 12.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.05432,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.05432,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.523332,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.92,
          "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": 12.92,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF NATRIURETIC PEPTIDE",
  "code_information": [
    {
      "code": "83880",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 21.44,
      "maximum": 39.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.43596,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.43596,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.938546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.26,
          "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": 39.26,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF NEONATAL THYROXINE",
  "code_information": [
    {
      "code": "84437",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.53,
      "maximum": 6.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.769037,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.47,
          "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": 6.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF NICKEL",
  "code_information": [
    {
      "code": "83885",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.38,
      "maximum": 24.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.38246,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.38246,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.066321,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF NOS VITAMIN",
  "code_information": [
    {
      "code": "84591",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.31,
      "maximum": 17.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.31476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.31476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.574926,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF NUCLEOTIDASE",
  "code_information": [
    {
      "code": "83915",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.09,
      "maximum": 11.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.0879,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.0879,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.218665,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF OSTEOCALCIN",
  "code_information": [
    {
      "code": "83937",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.3,
      "maximum": 29.85,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.2981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.2981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.002435,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.85,
          "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": 29.85,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF OXALATE",
  "code_information": [
    {
      "code": "83945",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.89,
      "maximum": 14.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.8897,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.8897,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.651095,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.45,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PARATHORMONE",
  "code_information": [
    {
      "code": "83970",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22.54,
      "maximum": 41.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.53888,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.53888,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.427488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.28,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PHENOBARBITAL",
  "code_information": [
    {
      "code": "80184",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.35,
      "maximum": 15.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.3538,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.3538,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.27763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.3,
          "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": 15.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PHENYLKETONES",
  "code_information": [
    {
      "code": "84035",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.17,
      "maximum": 3.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.17308,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.17308,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.933658,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.98,
          "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": 3.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PHENYTOIN FREE",
  "code_information": [
    {
      "code": "80186",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.51,
      "maximum": 13.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.51296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.51296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.142496,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.76,
          "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": 13.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PHENYTOIN TOTAL",
  "code_information": [
    {
      "code": "80185",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.23,
      "maximum": 13.25,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.2345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.2345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.766575,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.25,
          "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": 13.25,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PHOSPHORUS",
  "code_information": [
    {
      "code": "84100",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.59,
      "maximum": 4.74,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.58804,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.58804,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.493854,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.74,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PORPHOBILINOGEN",
  "code_information": [
    {
      "code": "84110",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.61,
      "maximum": 8.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.60824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.60824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.221124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.44,
          "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": 8.44,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PREALBUMIN",
  "code_information": [
    {
      "code": "84134",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.97,
      "maximum": 14.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.96614,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.96614,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.754289,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PREGNANEDIOL",
  "code_information": [
    {
      "code": "84135",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.61,
      "maximum": 21.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.61342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.61342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.678117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.27,
          "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": 21.27,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PREGNANETRIOL",
  "code_information": [
    {
      "code": "84138",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.49,
      "maximum": 21.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.4933,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.4933,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.515955,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.05,
          "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": 21.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PREGNENOLONE",
  "code_information": [
    {
      "code": "84140",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.29,
      "maximum": 20.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.28582,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.28582,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.235857,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.67,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PRIMIDONE",
  "code_information": [
    {
      "code": "80188",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.06,
      "maximum": 16.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.05814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.05814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.228489,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROCAINAMIDE",
  "code_information": [
    {
      "code": "80190",
      "type": "HCPCS"
    },
    {
      "code": "80192",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.15,
      "maximum": 60.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.1455,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.1455,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.346425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.0,
          "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": 16.75,
          "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": 60.0,
          "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": 16.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROGESTERONE",
  "code_information": [
    {
      "code": "84144",
      "type": "HCPCS"
    },
    {
      "code": "84234",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.39,
      "maximum": 64.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.38956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.42448,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.38956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.42448,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.375906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.823048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.86,
          "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": 64.88,
          "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": 20.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROINSULIN",
  "code_information": [
    {
      "code": "84206",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.57,
      "maximum": 26.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.57274,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.57274,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.673199,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.69,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.69,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROLACTIN",
  "code_information": [
    {
      "code": "84146",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.58,
      "maximum": 19.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.58148,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.58148,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.284998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.38,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROSTAGLANDIN",
  "code_information": [
    {
      "code": "84150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22.81,
      "maximum": 41.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.80642,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.80642,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.788667,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.77,
          "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": 41.77,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROTEIN ANY SOURCE",
  "code_information": [
    {
      "code": "84160",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.06,
      "maximum": 5.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.06306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.06306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.135131,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.61,
          "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": 5.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROTEIN OTHER",
  "code_information": [
    {
      "code": "84157",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.18,
      "maximum": 4.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.9484,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.0,
          "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": 4.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROTEIN SERUM",
  "code_information": [
    {
      "code": "84155",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 3.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.00382,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.00382,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.705157,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.67,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PROTEIN URINE",
  "code_information": [
    {
      "code": "84156",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.0,
      "maximum": 3.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.00382,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.00382,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.705157,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.67,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PSA COMPLEXED",
  "code_information": [
    {
      "code": "84152",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.04,
      "maximum": 18.39,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.04094,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.04094,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.555269,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.39,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PSA FREE",
  "code_information": [
    {
      "code": "84154",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.04,
      "maximum": 18.39,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.04094,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.04094,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.555269,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.39,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PSA TOTAL",
  "code_information": [
    {
      "code": "84153",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.04,
      "maximum": 18.39,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.04094,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.04094,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.555269,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.39,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PYRUVATE",
  "code_information": [
    {
      "code": "84210",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.91,
      "maximum": 14.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.90608,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.90608,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.673208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF PYRUVATE KINASE",
  "code_information": [
    {
      "code": "84220",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.15,
      "maximum": 9.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.15424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.15424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.958224,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.44,
          "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": 9.44,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF QUINIDINE",
  "code_information": [
    {
      "code": "80194",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.97,
      "maximum": 14.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.9716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.9716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.76166,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY OF QUININE",
  "code_information": [
    {
      "code": "84228",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.35,
      "maximum": 11.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.34998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.34998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.572473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.63,
          "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": 11.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF RBC GALACTOKINASE",
  "code_information": [
    {
      "code": "82759",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.73,
      "maximum": 21.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.72808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.72808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.832908,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF RBC PG6D ENZYME",
  "code_information": [
    {
      "code": "84085",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.15,
      "maximum": 9.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.15424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.15424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.958224,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.44,
          "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": 9.44,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF RENIN",
  "code_information": [
    {
      "code": "84244",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.01,
      "maximum": 21.99,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.00654,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.00654,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.208829,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.99,
          "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": 21.99,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SELENIUM",
  "code_information": [
    {
      "code": "84255",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.94,
      "maximum": 25.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.93938,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.93938,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.818163,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.53,
          "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": 25.53,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SEMEN FRUCTOSE",
  "code_information": [
    {
      "code": "82757",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.47,
      "maximum": 17.34,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.46764,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.46764,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.781314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.34,
          "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": 17.34,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SEROTONIN",
  "code_information": [
    {
      "code": "84260",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.92,
      "maximum": 30.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.91508,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.91508,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.835358,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.98,
          "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": 30.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SERUM ALBUMIN",
  "code_information": [
    {
      "code": "82040",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.7,
      "maximum": 4.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.7027,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.7027,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.648645,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.95,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.95,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SERUM POTASSIUM",
  "code_information": [
    {
      "code": "84132",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.6,
      "maximum": 4.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.59896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.59896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.508596,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.76,
          "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": 4.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SERUM SODIUM",
  "code_information": [
    {
      "code": "84295",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.63,
      "maximum": 4.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.62626,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.62626,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.545451,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.81,
          "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": 4.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SEX HORMONE GLOBUL",
  "code_information": [
    {
      "code": "84270",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.86,
      "maximum": 21.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.86458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.86458,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.017183,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.73,
          "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": 21.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SIALIC ACID",
  "code_information": [
    {
      "code": "84275",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.34,
      "maximum": 13.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.33824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.33824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.906624,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY OF SILICA",
  "code_information": [
    {
      "code": "84285",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.76,
      "maximum": 25.21,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.76466,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.76466,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.582291,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.21,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.21,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SIROLIMUS",
  "code_information": [
    {
      "code": "80195",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.5,
      "maximum": 13.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.49658,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.49658,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.120383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.73,
          "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": 13.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SOMATOMEDIN",
  "code_information": [
    {
      "code": "84305",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.61,
      "maximum": 21.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.60796,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.60796,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.670746,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.26,
          "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": 21.26,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SOMATOSTATIN",
  "code_information": [
    {
      "code": "84307",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.98,
      "maximum": 18.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.98088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.98088,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.474188,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.28,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF SWEAT SODIUM",
  "code_information": [
    {
      "code": "84302",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.65,
      "maximum": 4.86,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.65356,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.65356,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.582306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.86,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TACROLIMUS",
  "code_information": [
    {
      "code": "80197",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.5,
      "maximum": 13.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.49658,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.49658,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.120383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.73,
          "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": 13.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF THEOPHYLLINE",
  "code_information": [
    {
      "code": "80198",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.72,
      "maximum": 14.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.72044,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.72044,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.422594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF THIOCYANATE",
  "code_information": [
    {
      "code": "84430",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.35,
      "maximum": 11.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.34998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.34998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.572473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.63,
          "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": 11.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF THYROGLOBULIN",
  "code_information": [
    {
      "code": "84432",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.77,
      "maximum": 16.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.76876,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.76876,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.837826,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF THYROID (T3 OR T4)",
  "code_information": [
    {
      "code": "84479",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.53,
      "maximum": 6.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.769037,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.47,
          "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": 6.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF THYROID ACTIVITY",
  "code_information": [
    {
      "code": "84442",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.07,
      "maximum": 14.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.06988,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.06988,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.894338,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.78,
          "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": 14.78,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TOBRAMYCIN",
  "code_information": [
    {
      "code": "80200",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.81,
      "maximum": 16.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.80698,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.80698,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.889423,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.13,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TOPIRAMATE",
  "code_information": [
    {
      "code": "80201",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.51,
      "maximum": 11.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.50832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.50832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.786232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.92,
          "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": 11.92,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TOTAL ESTRADIOL",
  "code_information": [
    {
      "code": "82670",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.26,
      "maximum": 27.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.25524,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.25524,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.594574,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.94,
          "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": 27.94,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TOTAL TESTOSTERONE",
  "code_information": [
    {
      "code": "84403",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.09,
      "maximum": 25.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.09226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.09226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.024551,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.81,
          "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": 25.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TOTAL THYROXINE",
  "code_information": [
    {
      "code": "84436",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.75,
      "maximum": 6.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.75102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.75102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.063877,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.87,
          "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": 6.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TRANSCORTIN",
  "code_information": [
    {
      "code": "84449",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.83,
      "maximum": 18.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.828,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.828,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.2678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.0,
          "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": 18.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TRANSFERRIN",
  "code_information": [
    {
      "code": "84466",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.97,
      "maximum": 12.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.96696,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.96696,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.405396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.76,
          "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": 12.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TRIGLYCERIDES",
  "code_information": [
    {
      "code": "84478",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.13,
      "maximum": 5.74,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.13404,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.13404,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.230954,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.74,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TROPONIN QUAL",
  "code_information": [
    {
      "code": "84512",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.51,
      "maximum": 10.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.50914,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.50914,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.437339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.09,
          "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": 10.09,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TROPONIN QUANT",
  "code_information": [
    {
      "code": "84484",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.81,
      "maximum": 12.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.80862,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.80862,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.191637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.47,
          "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": 12.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TSI GLOBULIN",
  "code_information": [
    {
      "code": "84445",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.77,
      "maximum": 50.86,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.76956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.76956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.488906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.86,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF TYROSINE",
  "code_information": [
    {
      "code": "84510",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.8,
      "maximum": 10.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.80398,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.80398,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.835373,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.63,
          "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": 10.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF UREA NITROGEN",
  "code_information": [
    {
      "code": "84520",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.16,
      "maximum": 3.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.1567,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.1567,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.911545,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.95,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.95,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE CHLORIDE",
  "code_information": [
    {
      "code": "82436",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.14,
      "maximum": 5.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.1395,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.1395,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.238325,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.75,
          "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": 5.75,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE CREATININE",
  "code_information": [
    {
      "code": "82570",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.83,
      "maximum": 5.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.82828,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.82828,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.818178,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.18,
          "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": 5.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE OSMOLALITY",
  "code_information": [
    {
      "code": "83935",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.72,
      "maximum": 6.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.72372,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.72372,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.027022,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.82,
          "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": 6.82,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE PHOSPHORUS",
  "code_information": [
    {
      "code": "84105",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.16,
      "maximum": 5.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.15588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.15588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.260438,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.78,
          "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": 5.78,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE PORPHYRINS",
  "code_information": [
    {
      "code": "84120",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.03,
      "maximum": 14.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.03166,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.03166,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.842741,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.71,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE POTASSIUM",
  "code_information": [
    {
      "code": "84133",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.58,
      "maximum": 4.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.58258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.58258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.486483,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.73,
          "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": 4.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE SODIUM",
  "code_information": [
    {
      "code": "84300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.76,
      "maximum": 5.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.76276,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.76276,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.729726,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE SULFATE",
  "code_information": [
    {
      "code": "84392",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.0,
      "maximum": 5.49,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.99754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.99754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.046679,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.49,
          "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": 5.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE UROBILINOGEN",
  "code_information": [
    {
      "code": "84580",
      "type": "HCPCS"
    },
    {
      "code": "84583",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.3,
      "maximum": 9.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.2143,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.3033,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.2143,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.3033,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.039305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.459455,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.55,
          "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": 6.05,
          "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": 9.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE VMA",
  "code_information": [
    {
      "code": "84585",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.46,
      "maximum": 15.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.463,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.463,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.42505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.5,
          "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": 15.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE/UREA-N",
  "code_information": [
    {
      "code": "84540",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.04,
      "maximum": 5.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.03576,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.03576,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.098276,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.56,
          "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": 5.56,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF URINE/URIC ACID",
  "code_information": [
    {
      "code": "84560",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.77,
      "maximum": 5.08,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.77368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.77368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.744468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.08,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF VANCOMYCIN",
  "code_information": [
    {
      "code": "80202",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.39,
      "maximum": 13.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.39284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.39284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.980334,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF VASOPRESSIN",
  "code_information": [
    {
      "code": "84588",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18.53,
      "maximum": 33.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.53124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.53124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.017174,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY OF VIP",
  "code_information": [
    {
      "code": "84586",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.29,
      "maximum": 35.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.29018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.29018,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.041743,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.33,
          "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": 35.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF VITAMIN A",
  "code_information": [
    {
      "code": "84590",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.34,
      "maximum": 11.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.33906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.33906,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.557731,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.61,
          "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": 11.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF VITAMIN B-1",
  "code_information": [
    {
      "code": "84425",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.59,
      "maximum": 21.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.59158,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.59158,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.648633,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF VITAMIN B-2",
  "code_information": [
    {
      "code": "84252",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.05,
      "maximum": 20.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.05104,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.05104,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.918904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF VITAMIN B-6",
  "code_information": [
    {
      "code": "84207",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.34,
      "maximum": 28.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.3426,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.3426,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.71251,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.1,
          "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": 28.1,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF VITAMIN E",
  "code_information": [
    {
      "code": "84446",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.74,
      "maximum": 14.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.74228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.74228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.452078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY OF VITAMIN K",
  "code_information": [
    {
      "code": "84597",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.49,
      "maximum": 13.72,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.49112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.49112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.113012,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.72,
          "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": 13.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF VOLATILES",
  "code_information": [
    {
      "code": "84600",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.34,
      "maximum": 17.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.34206,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.34206,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.611781,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.11,
          "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": 17.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OF ZINC",
  "code_information": [
    {
      "code": "84630",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.22,
      "maximum": 11.39,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.21894,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.21894,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.395569,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.39,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY OTHER FLUID CHLORIDES",
  "code_information": [
    {
      "code": "82438",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.73,
      "maximum": 5.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.6855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.0,
          "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": 5.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY PH BODY FLUID NOS",
  "code_information": [
    {
      "code": "83986",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.95,
      "maximum": 3.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.95468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.95468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.638818,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.58,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY PHOSPHATIDYLGLYCEROL",
  "code_information": [
    {
      "code": "84081",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.02,
      "maximum": 16.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.01992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.01992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.176892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY PHOSPHOHEXOSE ENZYMES",
  "code_information": [
    {
      "code": "84087",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.86,
      "maximum": 10.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.85858,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.85858,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.909083,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.73,
          "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": 10.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY PROSTATE PHOSPHATASE",
  "code_information": [
    {
      "code": "84066",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.27,
      "maximum": 9.66,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.27436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.27436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.120386,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.66,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY RBC CHOLINESTERASE",
  "code_information": [
    {
      "code": "82482",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.36,
      "maximum": 9.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.35626,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.35626,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.230951,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.81,
          "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": 9.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY RBC GLUTATHIONE",
  "code_information": [
    {
      "code": "82979",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.15,
      "maximum": 9.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.15424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.15424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.958224,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.44,
          "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": 9.44,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY RBC PROTOPORPHYRIN",
  "code_information": [
    {
      "code": "84202",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.84,
      "maximum": 14.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.8351,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.8351,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.577385,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.35,
          "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": 14.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY SERUM CHOLINESTERASE",
  "code_information": [
    {
      "code": "82480",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.3,
      "maximum": 7.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.29702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.29702,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.800977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.87,
          "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": 7.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY SPEC XCP UR&BREATH IA",
  "code_information": [
    {
      "code": "82077",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.43,
      "maximum": 17.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.42942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.42942,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.729717,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY SYNOVIAL FLUID MUCIN",
  "code_information": [
    {
      "code": "83872",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.2,
      "maximum": 5.86,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.19956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.19956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.319406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.86,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY TEST FOR BLOOD FECAL",
  "code_information": [
    {
      "code": "82274",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.69,
      "maximum": 15.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.69232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.69232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.734632,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.92,
          "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": 15.92,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY THREE CATECHOLAMINES",
  "code_information": [
    {
      "code": "82384",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.79,
      "maximum": 25.25,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.7865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.7865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.611775,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.25,
          "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": 25.25,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY THYROID STIM HORMONE",
  "code_information": [
    {
      "code": "84443",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.17,
      "maximum": 16.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.1728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.1728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.38328,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY TOTAL HYDROXYPROLINE",
  "code_information": [
    {
      "code": "83505",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.27,
      "maximum": 24.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.2678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.2678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.91153,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.3,
          "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": 24.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSAY TRIIODOTHYRONINE (T3)",
  "code_information": [
    {
      "code": "84480",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.74,
      "maximum": 14.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.74228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.74228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.452078,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ASSAY URINE CATECHOLAMINES",
  "code_information": [
    {
      "code": "82382",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.91,
      "maximum": 27.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.9058,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.9058,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.12283,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.3,
          "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": 27.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Assessment of a patient",
  "code_information": [
    {
      "code": "D0191",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.27,
      "maximum": 136.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.26692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.26692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.990077,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 136.02,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSESSMENT OF APHASIA",
  "code_information": [
    {
      "code": "96105",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.93,
      "maximum": 128.08,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.93168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.93168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 91.525707,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 128.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 128.08,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSIST OOCYTE FERTILIZATION",
  "code_information": [
    {
      "code": "89280",
      "type": "HCPCS"
    },
    {
      "code": "89281",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 95.04,
      "maximum": 823.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.42898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.03676,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.42898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.03676,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 602.13699,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 126.309456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 823.13,
          "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": 174.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 823.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 174.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSISTIVE TECHNOLOGY ASSESS",
  "code_information": [
    {
      "code": "97755",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 26.77,
      "maximum": 49.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.77038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.77038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.859915,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.03,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.03,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSMT & CARE PLN PT COG IMP",
  "code_information": [
    {
      "code": "99483",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 56.67,
      "maximum": 103.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.66934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.18175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103.79,
          "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": 103.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSTV ALG ALYS ACOUS&ECG REC",
  "code_information": [
    {
      "code": "0962T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSTV ALG ECG RSK ASMT CNCRT",
  "code_information": [
    {
      "code": "0764T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASSTV ALG ECG RSK ASMT PREV",
  "code_information": [
    {
      "code": "0765T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASXL1 FULL GENE SEQUENCE",
  "code_information": [
    {
      "code": "81175",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 369.37,
      "maximum": 676.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 369.369,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 369.369,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 498.64815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 676.5,
          "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": 676.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASXL1 GENE TARGET SEQ ALYS",
  "code_information": [
    {
      "code": "81176",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 132.08,
      "maximum": 241.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.0774,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.0774,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 178.30449,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 241.9,
          "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": 241.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASY CARBAMAZEPIN 10,11-EPXID",
  "code_information": [
    {
      "code": "80161",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.18,
      "maximum": 18.64,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.17744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.17744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.739544,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.64,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASY HYDROXYCORTICOSTEROIDS17",
  "code_information": [
    {
      "code": "83491",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.77,
      "maximum": 17.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.7734,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.7734,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.19409,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.9,
          "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": 17.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASY HYDROXYPROGESTERONE 17-D",
  "code_information": [
    {
      "code": "83498",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.83,
      "maximum": 27.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.83482,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.83482,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.027007,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.17,
          "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": 27.17,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASY THIOPURIN S-MTHYLTRNSFRS",
  "code_information": [
    {
      "code": "84433",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.1,
      "maximum": 22.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.10482,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.10482,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.341507,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.17,
          "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": 22.17,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ATAZANAVIR SULFATE 200 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "65862071260",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.68,
      "maximum": 6.33,
      "gross_charge": 6.73,
      "discounted_cash": 3.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.56294,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.67458,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.3262,
          "standard_charge_percentage": 94.0,
          "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": 2.465872,
          "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": 1.972563,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 5.70704,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.67458,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5.384,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.7205,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.9897,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.9897,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.02335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.02335,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.8361,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.057,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.057,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.67458,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.3262,
          "standard_charge_percentage": 94.0,
          "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": 3.19675,
          "standard_charge_percentage": 47.5,
          "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": 1.6825,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATAZANAVIR SULFATE 300 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00093552856",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.97,
      "maximum": 22.43,
      "gross_charge": 23.86,
      "discounted_cash": 13.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.17708,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.02756,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.4284,
          "standard_charge_percentage": 94.0,
          "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": 6.993366,
          "standard_charge_percentage": 29.31,
          "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": 8.742304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 19.088,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.02756,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 20.23328,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.281,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.2354,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.2354,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.3547,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.3547,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.6002,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.474,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.474,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.02756,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.4284,
          "standard_charge_percentage": 94.0,
          "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": 11.3335,
          "standard_charge_percentage": 47.5,
          "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": 5.965,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATAZANAVIR-COBICISTAT 300-150 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00003364111",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 30.29,
      "maximum": 113.9,
      "gross_charge": 121.17,
      "discounted_cash": 66.64,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 82.15326,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66.15882,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 113.8998,
          "standard_charge_percentage": 94.0,
          "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": 44.396688,
          "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": 35.514927,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66.15882,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 96.936,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 102.75216,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 102.9945,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 107.8413,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 107.8413,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 108.44715,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 108.44715,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 69.0669,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 109.053,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 109.053,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66.15882,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 113.8998,
          "standard_charge_percentage": 94.0,
          "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": 57.55575,
          "standard_charge_percentage": 47.5,
          "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": 30.2925,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATENOLOL 10 MG/ML SUSPENSION",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "P5107975920",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATENOLOL 100 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "51079068520",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATENOLOL 12.5  MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "R0378021801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATENOLOL 25 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "51079075920",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATENOLOL 50 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "51079068420",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATEZOLIZUMAB 1200 MG/20ML IV SOLN",
  "drug_information": {
    "unit": 20.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "50242091701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 51.27,
      "maximum": 30805.93,
      "gross_charge": 32772.27,
      "discounted_cash": 18024.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22219.59906,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.27486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30805.9338,
          "standard_charge_percentage": 94.0,
          "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": 12007.759728,
          "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": 9605.552337,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 95.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.27486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 98.5065,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27856.4295,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29167.3203,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29167.3203,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29331.18165,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29331.18165,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 18680.1939,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29495.043,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29495.043,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 63.567504,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 93.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30805.9338,
          "standard_charge_percentage": 94.0,
          "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": 15566.82825,
          "standard_charge_percentage": 47.5,
          "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": 93.91,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATM MRNA SEQ ALYS",
  "code_information": [
    {
      "code": "0136U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 222.46,
      "maximum": 407.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 222.45678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 222.45678,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.316653,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 407.43,
          "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": 407.43,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ATN1 GENE DETC ABNOR ALLELES",
  "code_information": [
    {
      "code": "81177",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ATOMIC ABSORPTION",
  "code_information": [
    {
      "code": "82190",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.68,
      "maximum": 15.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.6814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.6814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.71989,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.9,
          "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": 15.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ATOMOXETINE HCL 10 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "55111051930",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATOMOXETINE HCL 18 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "64980037403",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATOMOXETINE HCL 25 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687056721",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.06,
      "maximum": 3.97,
      "gross_charge": 4.22,
      "discounted_cash": 2.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.86116,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.30412,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.9668,
          "standard_charge_percentage": 94.0,
          "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": 1.546208,
          "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": 1.236882,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.30412,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.376,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.57856,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.587,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.7558,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.7558,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.7769,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.7769,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.4054,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.798,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.798,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.30412,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.9668,
          "standard_charge_percentage": 94.0,
          "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": 2.0045,
          "standard_charge_percentage": 47.5,
          "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": 1.055,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATOMOXETINE HCL 40 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687032625",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.62,
      "maximum": 6.09,
      "gross_charge": 6.48,
      "discounted_cash": 3.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.39344,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53808,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.0912,
          "standard_charge_percentage": 94.0,
          "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": 2.374272,
          "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": 1.899288,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53808,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 5.49504,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5.184,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.508,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.7672,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.7672,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.7996,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.7996,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.6936,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.832,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.832,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53808,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.0912,
          "standard_charge_percentage": 94.0,
          "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": 3.078,
          "standard_charge_percentage": 47.5,
          "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": 1.62,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATOMOXETINE HCL 60 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00093354656",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.28,
      "maximum": 8.56,
      "gross_charge": 9.11,
      "discounted_cash": 5.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.17658,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.97406,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.5634,
          "standard_charge_percentage": 94.0,
          "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": 3.337904,
          "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": 2.670141,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 7.288,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.97406,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 7.72528,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.7435,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.1079,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.1079,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.15345,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.15345,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.1927,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.199,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.199,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.97406,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.5634,
          "standard_charge_percentage": 94.0,
          "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": 4.32725,
          "standard_charge_percentage": 47.5,
          "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": 2.2775,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATOMOXETINE HCL 80 MG PO CAPS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "55111056330",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATORVASTATIN CALCIUM 10 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68084009701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATORVASTATIN CALCIUM 20 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00904629161",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATORVASTATIN CALCIUM 40 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68084009901",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.4656,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATORVASTATIN CALCIUM 80 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68084059025",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.0,
      "maximum": 3.76,
      "gross_charge": 4.0,
      "discounted_cash": 2.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.712,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.1724,
          "standard_charge_percentage": 29.31,
          "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": 1.4656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 3.392,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.2,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.58,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.28,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.6,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.184,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.76,
          "standard_charge_percentage": 94.0,
          "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": 1.9,
          "standard_charge_percentage": 47.5,
          "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": 1.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATOVAQUONE 750 MG/5ML PO SUSP",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60687053478",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.08,
      "maximum": 22.87,
      "gross_charge": 24.33,
      "discounted_cash": 13.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.49574,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.28418,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8702,
          "standard_charge_percentage": 94.0,
          "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": 8.914512,
          "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": 7.131123,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 20.63184,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.28418,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 19.464,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.6805,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.6537,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.6537,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.77535,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.77535,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.8681,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.897,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.897,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.28418,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.8702,
          "standard_charge_percentage": 94.0,
          "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": 11.55675,
          "standard_charge_percentage": 47.5,
          "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": 6.0825,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68001024515",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.71,
      "maximum": 6.42,
      "gross_charge": 6.83,
      "discounted_cash": 3.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.63074,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.72918,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.4202,
          "standard_charge_percentage": 94.0,
          "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": 2.001873,
          "standard_charge_percentage": 29.31,
          "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": 2.502512,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 5.79184,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.72918,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 5.464,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.8055,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.0787,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.0787,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.11285,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.11285,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.8931,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.147,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.147,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.72918,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.4202,
          "standard_charge_percentage": 94.0,
          "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": 3.24425,
          "standard_charge_percentage": 47.5,
          "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": 1.7075,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00378416001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.2,
      "maximum": 4.5,
      "gross_charge": 4.79,
      "discounted_cash": 2.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.24762,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.61534,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.5026,
          "standard_charge_percentage": 94.0,
          "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": 1.403949,
          "standard_charge_percentage": 29.31,
          "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": 1.755056,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 4.06192,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.61534,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 3.832,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.0715,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.2631,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.2631,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.28705,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.28705,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.7303,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.311,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.311,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.61534,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.5026,
          "standard_charge_percentage": 94.0,
          "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": 2.27525,
          "standard_charge_percentage": 47.5,
          "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": 1.1975,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATRACURIUM BESYLATE 50 MG/5ML IV SOLN",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "55150021605",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 91.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATRAPRO DERMAL SPRAY EX LIQD",
  "drug_information": {
    "unit": 236.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "23710006508",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 156.15,
      "maximum": 587.11,
      "gross_charge": 624.58,
      "discounted_cash": 343.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 423.46524,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 341.02068,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 587.1052,
          "standard_charge_percentage": 94.0,
          "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": 183.064398,
          "standard_charge_percentage": 29.31,
          "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": 228.846112,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 341.02068,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 529.64384,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 499.664,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 530.893,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 555.8762,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 555.8762,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 558.9991,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 558.9991,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 356.0106,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 562.122,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 562.122,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 341.02068,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 587.1052,
          "standard_charge_percentage": 94.0,
          "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": 296.6755,
          "standard_charge_percentage": 47.5,
          "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": 156.145,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATRAPRO HYDROGEL EX GEL",
  "drug_information": {
    "unit": 113.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "23710006004",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 137.52,
      "maximum": 517.08,
      "gross_charge": 550.08,
      "discounted_cash": 302.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 372.95424,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.34368,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 517.0752,
          "standard_charge_percentage": 94.0,
          "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": 201.549312,
          "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": 161.228448,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.34368,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 440.064,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 466.46784,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 467.568,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 489.5712,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 489.5712,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 492.3216,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 492.3216,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 313.5456,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 495.072,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 495.072,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.34368,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 517.0752,
          "standard_charge_percentage": 94.0,
          "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": 261.288,
          "standard_charge_percentage": 47.5,
          "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": 137.52,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE 0.4 MG/ML 20ML (BULK CHARGE)",
  "drug_information": {
    "unit": 20.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "16729051243",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.23,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Atropine comp con",
  "code_information": [
    {
      "code": "J7635",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.71,
      "maximum": 1.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.7085,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.71,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Atropine comp unit",
  "code_information": [
    {
      "code": "J7636",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.06,
      "maximum": 1.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.0625,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Atropine sulf, nte, 0.01 mg",
  "code_information": [
    {
      "code": "J0462",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.16,
      "maximum": 0.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.1615,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 0.1 MG/ML IJ SOLN 10ML SYRINGE (BULK CHARGE)",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "76329334001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.23,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 0.1 MG/ML IJ SOLN- CODE USE PEDS",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "76329334001_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.23,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 0.25 MG/5ML IJ SOSY",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00409963005",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 0.4 MG/ML IV SOLN",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00517100425",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.23,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 1 % OP SOLN",
  "drug_information": {
    "unit": 5.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60219174903",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 21.31,
      "maximum": 80.12,
      "gross_charge": 85.23,
      "discounted_cash": 46.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.78594,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.53558,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 80.1162,
          "standard_charge_percentage": 94.0,
          "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": 24.980913,
          "standard_charge_percentage": 29.31,
          "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": 31.228272,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 72.27504,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 68.184,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.53558,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72.4455,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.8547,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.8547,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.28085,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.28085,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 48.5811,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.707,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.707,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.53558,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.1162,
          "standard_charge_percentage": 94.0,
          "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": 40.48425,
          "standard_charge_percentage": 47.5,
          "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": 21.3075,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 1 MG/10ML IJ SOSY",
  "drug_information": {
    "unit": 10.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "76329334001_3",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.23,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 1 MG/ML IV SOLN",
  "drug_information": {
    "unit": 1.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "00517100125",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.23,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "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": 14.656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 1% OP SOLN 2ML (BULK CHARGE)",
  "drug_information": {
    "unit": 2.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "60219174802",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17.46,
      "maximum": 65.66,
      "gross_charge": 69.85,
      "discounted_cash": 38.42,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.3583,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.1381,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.659,
          "standard_charge_percentage": 94.0,
          "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": 25.59304,
          "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": 20.473035,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 59.2328,
          "standard_charge_percentage": 84.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.1381,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 55.88,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.3725,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.1665,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.1665,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.51575,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.51575,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 39.8145,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.865,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.865,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.1381,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.659,
          "standard_charge_percentage": 94.0,
          "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": 33.17875,
          "standard_charge_percentage": 47.5,
          "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": 17.4625,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 1.2 MG/3ML IV SOSY",
  "drug_information": {
    "unit": 3.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "69374093503",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.0,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "median_amount": 27.2,
          "10th_percentile": 27.12,
          "90th_percentile": 44.4,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "median_amount": 6.8,
          "10th_percentile": 6.8,
          "90th_percentile": 45.0,
          "count": "62",
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "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": 33.92,
          "standard_charge_percentage": 84.8,
          "median_amount": 31.8,
          "10th_percentile": 6.74,
          "90th_percentile": 43.73,
          "count": "11",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "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": 32.0,
          "standard_charge_percentage": 80.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "median_amount": 24.69,
          "10th_percentile": 21.95,
          "90th_percentile": 28.36,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "median_amount": 28.54,
          "10th_percentile": 28.54,
          "90th_percentile": 32.25,
          "count": "11",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "median_amount": 28.54,
          "10th_percentile": 28.54,
          "90th_percentile": 32.25,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "median_amount": 23.96,
          "10th_percentile": 22.8,
          "90th_percentile": 26.96,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "Estimated Allowed derived from 12 months prior to as of date of historical Payer/Plan specific claim"
    }
  ]
},
{
  "description": "ATROPINE SULFATE 8 MG/20ML IJ SOLN",
  "drug_information": {
    "unit": 20.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "16729051243_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.23,
      "maximum": 37.6,
      "gross_charge": 40.0,
      "discounted_cash": 22.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.12,
          "standard_charge_percentage": 67.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 14.656,
          "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": 11.724,
          "standard_charge_percentage": 29.31,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.306,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.0,
          "standard_charge_percentage": 85.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Evernorth",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.6,
          "standard_charge_percentage": 89.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO-Eating Disorder",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.8,
          "standard_charge_percentage": 89.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Kaiser",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.8,
          "standard_charge_percentage": 57.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Multiplan",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Private Healthcare System PHC- PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.0,
          "standard_charge_percentage": 90.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.84,
          "standard_charge_percentage": 54.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. 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 - PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.6,
          "standard_charge_percentage": 94.0,
          "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": 19.0,
          "standard_charge_percentage": 47.5,
          "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": 10.0,
          "standard_charge_percentage": 25.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ATTACH BLADDER/URETHRA",
  "code_information": [
    {
      "code": "51840",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2790.5,
      "maximum": 5110.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2790.4968,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2790.4968,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5110.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5110.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ATTACH OCULAR IMPLANT",
  "code_information": [
    {
      "code": "65140",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2193.04,
      "maximum": 4016.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2193.0363,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2193.0363,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2779.6041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4016.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4016.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ATXN1 GENE DETC ABNOR ALLELE",
  "code_information": [
    {
      "code": "81178",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ATXN10 GENE DETC ABNOR ALLEL",
  "code_information": [
    {
      "code": "81183",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ATXN2 GENE DETC ABNOR ALLELE",
  "code_information": [
    {
      "code": "81179",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ATXN3 GENE DETC ABNOR ALLELE",
  "code_information": [
    {
      "code": "81180",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ATXN7 GENE DETC ABNOR ALLELE",
  "code_information": [
    {
      "code": "81181",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "ATXN8OS GEN DETC ABNOR ALLEL",
  "code_information": [
    {
      "code": "81182",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.8,
      "maximum": 137.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.802,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 100.9827,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "AUD BRAINSTEM IMPLT PROGRAMG",
  "code_information": [
    {
      "code": "92640",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 71.78,
      "maximum": 131.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115.326666,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.46,
          "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": 131.46,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUDIOMETRY AIR & BONE",
  "code_information": [
    {
      "code": "0209T",
      "type": "HCPCS"
    },
    {
      "code": "92553",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.84,
      "maximum": 131.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.931175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115.326666,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.16,
          "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": 131.46,
          "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": 38.16,
          "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": 131.46,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUDIOMETRY AIR ONLY",
  "code_information": [
    {
      "code": "0208T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.84,
      "maximum": 38.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.83536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.931175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.16,
          "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": 38.16,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUDITORY FUNCTION 60 MIN",
  "code_information": [
    {
      "code": "92620",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 71.78,
      "maximum": 131.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.77716,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115.326666,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.46,
          "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": 131.46,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUGMENTATION CHEEK BONE",
  "code_information": [
    {
      "code": "21270",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3302.24,
      "maximum": 6048.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4360.432986,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6048.05,
          "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": 6048.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUGMENTATION MNDBLR B1 GRF",
  "code_information": [
    {
      "code": "21127",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3302.24,
      "maximum": 6048.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4360.432986,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6048.05,
          "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": 6048.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUGMENTATION MNDBLR PROSTC",
  "code_information": [
    {
      "code": "21125",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3302.24,
      "maximum": 6048.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4360.432986,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6048.05,
          "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": 6048.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUGMENTATION OF FACIAL BONES",
  "code_information": [
    {
      "code": "21208",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3302.24,
      "maximum": 6048.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3302.2353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4360.432986,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6048.05,
          "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": 6048.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUGMNT AI-BASED FCL PHNT A/R",
  "code_information": [
    {
      "code": "0731T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 32.91,
      "maximum": 60.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.90742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.90742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.78374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.27,
          "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": 60.27,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUGMNT ALYS CH CT ILD W/CT",
  "code_information": [
    {
      "code": "0878T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 355.17,
      "maximum": 650.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 355.173,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 355.173,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 479.48355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 650.5,
          "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": 650.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUGMNT ALYS CH CT ILD W/O CT",
  "code_information": [
    {
      "code": "0877T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 355.17,
      "maximum": 650.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 355.173,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 355.173,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 479.48355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 650.5,
          "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": 650.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTGRFT IMPLNT KNEE W/SCOPE",
  "code_information": [
    {
      "code": "29866",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTO ALYS BINOCULAR EYE MVMT",
  "code_information": [
    {
      "code": "0615T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 74.22,
      "maximum": 135.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.21778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.01219,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 135.93,
          "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": 135.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTO QUAN C PLAQ CPTR ALYS",
  "code_information": [
    {
      "code": "0625T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 700.61,
      "maximum": 700.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 700.61355,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Auto tissue graft 1st tooth",
  "code_information": [
    {
      "code": "D4273",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 865.51,
      "maximum": 1585.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 865.51374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1091.851488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1585.19,
          "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": 1585.19,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTOCHONDROCYTE IMPLANT KNEE",
  "code_information": [
    {
      "code": "27412",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4047.71,
      "maximum": 7413.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4047.70548,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5265.643383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.38,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTOIMMUNE RA ALYS 12 BMRK",
  "code_information": [
    {
      "code": "81490",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 458.99,
      "maximum": 840.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 458.9949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 458.9949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 619.643115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item 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": "AUTOINFLAM DS VEXAS SYND DNA",
  "code_information": [
    {
      "code": "0500U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 95.77,
      "maximum": 175.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.7684,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.7684,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 129.28734,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 175.4,
          "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": 175.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Autolog prp diab wound ulcer",
  "code_information": [
    {
      "code": "G0465",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1150.95,
      "maximum": 2107.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1348.325433,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2107.97,
          "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": 2107.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Autolog prp not diab ulcer",
  "code_information": [
    {
      "code": "G0460",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1150.95,
      "maximum": 2107.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1150.95162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1348.325433,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2107.97,
          "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": 2107.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTOLOGOUS BLOOD OP SALVAGE",
  "code_information": [
    {
      "code": "86891",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 449.43,
      "maximum": 823.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.42898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.42898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 602.13699,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 823.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 823.13,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTOLOGOUS BLOOD PROCESS",
  "code_information": [
    {
      "code": "86890",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 95.04,
      "maximum": 174.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.03676,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 95.03676,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 126.309456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 174.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 174.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTOMATED DIFF WBC COUNT",
  "code_information": [
    {
      "code": "85004",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.53,
      "maximum": 6.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.53262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "SCAN",
          "plan_name": "Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.769037,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.47,
          "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": 6.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AUTOMATED LEUKOCYTE COUNT",
  "code_information": [
    {
      "code": "85048",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.39,
      "maximum": 2.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare",
          "plan_name": "Medicare",
          "additional_payer_notes": "L